Provider Demographics
NPI:1144489840
Name:VILLANUEVA-FISCHBERG, GEZEL TAMAYO (MS, PT)
Entity type:Individual
Prefix:
First Name:GEZEL
Middle Name:TAMAYO
Last Name:VILLANUEVA-FISCHBERG
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:GEZEL
Other - Middle Name:TAMAYO
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:1626 HUDSON PARK
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1570
Mailing Address - Country:US
Mailing Address - Phone:646-977-9548
Mailing Address - Fax:
Practice Address - Street 1:3 E 65TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6527
Practice Address - Country:US
Practice Address - Phone:212-535-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010519-1225100000X
NJ40QA00726200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist