Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 038911 | NY |
NPI | 1003457086 |
---|---|
Provider Name | Mr. Bryan Joel Villanueva Nitural |
First Address | Woodside, NY 11377-8904 |
Second Address | New York, NY 10017-4530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2019 |
Last Update Date | 01/10/2019 |