Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003875L | PA |
Y | 222Z00000X | Podiatrist | SC003875L | PA |
N | 213ES0131X | Foot Surgery | SC003875L | PA |
NPI | 1346233053 |
---|---|
Provider Name | Dr. Edward Eusebio Villanueva |
First Address | Drexel Hill, PA 19026-1010 |
Second Address | Drexel Hill, PA 19026-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2005 |
Last Update Date | 07/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015260540002 | (05) | PA |
U56365 | (02) | PA |