Provider Demographics
NPI:1912093485
Name:VILLA-LORENO, B PRESENTA L (MD)
Entity Type:Individual
Prefix:DR
First Name:B PRESENTA
Middle Name:L
Last Name:VILLA-LORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BABY P
Other - Middle Name:L
Other - Last Name:VILLA-LORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:717 NORTH BEERS STREET
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-739-2810
Mailing Address - Fax:732-739-4681
Practice Address - Street 1:717 NORTH BEERS STREET
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-739-2810
Practice Address - Fax:732-739-4681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03225100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI 104400Medicare ID - Type Unspecified
E70402Medicare UPIN