Provider Demographics
NPI:1538252168
Name:VILLEGAS, PABLO (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 YORK AVENUE
Mailing Address - Street 2:APT 15D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-996-7331
Mailing Address - Fax:
Practice Address - Street 1:600 EAST 125TH STREET
Practice Address - Street 2:WARDS ISLAND
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:646-672-6212
Practice Address - Fax:646-672-6538
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221125-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY211125-A37OtherHEALTHFIRST
NYH99626Medicare UPIN
NY03823WMedicare ID - Type UnspecifiedMEDICARE # WITH IPR/HE