Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA04703400 | NJ |
N | 208600000X | Surgeon | 25MA04703400 | NJ |
N | 208200000X | Surgeon | C10005653 | DE |
N | 208600000X | Surgeon | C10005653 | DE |
N | 208200000X | Surgeon | MD039406L | PA |
N | 208600000X | Surgeon | MD039406L | PA |
N | 2086S0129X | Vascular Surgeon | 25MA04703400 | NJ |
N | 2086S0129X | Vascular Surgeon | C10005653 | DE |
Y | 2086S0129X | Vascular Surgeon | MD039406L | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA04703400 | NJ |
N | 208G00000X | Cardiothoracic Vascular Surgeon | C10005653 | DE |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD039406L | PA |
NPI | 1124012273 |
---|---|
Provider Name | Dr. Robert C Villare |
First Address | Woodbury, NJ 08096-1178 |
Second Address | Woodbury, NJ 08096-1178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 18/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000002081 | (05) | DE |
B96854 | (02) |