Provider Demographics
NPI:1124124334
Name:JUNIO, VILMA (MD)
Entity type:Individual
Prefix:DR
First Name:VILMA
Middle Name:
Last Name:JUNIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VILMA
Other - Middle Name:
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 W UTICA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3165
Mailing Address - Country:US
Mailing Address - Phone:315-342-4217
Mailing Address - Fax:315-342-7205
Practice Address - Street 1:101 W UTICA ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3165
Practice Address - Country:US
Practice Address - Phone:315-342-4217
Practice Address - Fax:315-342-7205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2333061208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02605847Medicaid