Individual
JEFFREY VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 IRVIG AVE, SUITE 403, SYRACUSE, NY 13210-2306
(315) 464-6060
(315) 464-2879
Mailing address
725 IRVING AVE STE 403, SYRACUSE, NY 13210-1684
(315) 464-6060
(315) 464-2879
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
MD467016
PA
2088P0231X
Pediatric Urology Physician
Primary
302506
NY
2088P0231X
Pediatric Urology Physician
MD467016
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT215493
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2013
Last updated
07/20/2020
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