Provider Demographics
NPI:1720248628
Name:VILLAS, ERNESTO N (RPT)
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:N
Last Name:VILLAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5828 44TH AVE APT 11G
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7790
Mailing Address - Country:US
Mailing Address - Phone:347-204-6099
Mailing Address - Fax:347-204-6099
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:347-495-6566
Practice Address - Fax:718-676-5508
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY022729-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist