Individual
JOCELYN VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 EDGEWATER ST, 1ST FL. LAB, STATEN ISLAND, NY 10305-4900
(718) 226-4130
(718) 226-4185
Mailing address
1 EDGEWATER ST, 6TH FL. PAYER RELATIONS, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
212627
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02290811
—
NY
01
—
P00685818
RAILROAD MEDICARE
NY
Enumeration date
10/14/2005
Last updated
07/24/2009
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