Provider Demographics
NPI:1306960026
Name:VILLANUEVA, MIRANDA (MS, PA-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:YOUSSEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PAC
Mailing Address - Street 1:PO BOX 2680
Mailing Address - Street 2:CENTRAL JERSEY EMERGENCY MED ASSOC PC
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08903-2680
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:CENTRASTATE MEDICAL CENTER
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-294-2666
Practice Address - Fax:732-431-8267
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00177400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical