Provider Demographics
NPI:1386780963
Name:VILLEZ, JANINE
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:
Last Name:VILLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:
Other - Last Name:VERDONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1210
Mailing Address - Country:US
Mailing Address - Phone:631-325-0800
Mailing Address - Fax:
Practice Address - Street 1:390 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1210
Practice Address - Country:US
Practice Address - Phone:631-325-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008534-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist