Provider Demographics
NPI:1528147998
Name:VILLANI, GINA MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:VILLANI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:212-987-1777
Mailing Address - Fax:718-670-1180
Practice Address - Street 1:1919 MADISON AVE
Practice Address - Street 2:THE RALPH LAUREN CENTER FOR CANCER CARE AND PREVENTION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2745
Practice Address - Country:US
Practice Address - Phone:212-987-1777
Practice Address - Fax:212-987-1776
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183964207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY01647025Medicaid
NY00246075Medicaid
NYG26771Medicare UPIN