Provider Demographics
NPI:1710785639
Name:VILLANUEVA, ANTONIO VICTOR
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:VICTOR
Last Name:VILLANUEVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 KENNETH TER E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1224
Mailing Address - Country:US
Mailing Address - Phone:732-320-0833
Mailing Address - Fax:
Practice Address - Street 1:23 KENNETH TER E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1224
Practice Address - Country:US
Practice Address - Phone:732-320-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor