Provider Demographics
NPI:1194947945
Name:VILLASENOR, RANOL (MD)
Entity type:Individual
Prefix:DR
First Name:RANOL
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 STIRRUP DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8154
Mailing Address - Country:US
Mailing Address - Phone:732-308-0877
Mailing Address - Fax:732-308-0877
Practice Address - Street 1:570 LEE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3053
Practice Address - Country:US
Practice Address - Phone:732-442-1666
Practice Address - Fax:732-442-2661
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA038718002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA038718OtherNJ LICENSE NUMBER
NJ25MA038718OtherNJ LICENSE NUMBER