Provider Demographics
NPI:1407616642
Name:VILLAMIL, GERONIMA
Entity type:Individual
Prefix:
First Name:GERONIMA
Middle Name:
Last Name:VILLAMIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800A BROOKRIDGE DR APT 70
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1860
Mailing Address - Country:US
Mailing Address - Phone:845-367-3418
Mailing Address - Fax:
Practice Address - Street 1:17 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1613
Practice Address - Country:US
Practice Address - Phone:914-946-9559
Practice Address - Fax:914-946-9538
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator