Provider Demographics
NPI:1457353880
Name:VILLAROSA, TERESITA (NP)
Entity type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:
Last Name:VILLAROSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TERESITA
Other - Middle Name:
Other - Last Name:VILLAROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:772 BROOK AVE
Mailing Address - Street 2:APT B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4677
Mailing Address - Country:US
Mailing Address - Phone:212-523-4101
Mailing Address - Fax:212-523-1077
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:SLH- S&R 8TH FLOOR- EVALUATION UNIT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-523-4101
Practice Address - Fax:212-523-1077
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02060768Medicaid
NY02060768Medicaid