Provider Demographics
NPI:1760105506
Name:VILLANEUVA, ANTHONY ANSELMO
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ANSELMO
Last Name:VILLANEUVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 84TH ST.
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:347-829-3890
Mailing Address - Fax:347-829-3888
Practice Address - Street 1:5539 84TH ST.
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:347-829-3890
Practice Address - Fax:347-829-3888
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2025-12-18
Deactivation Date:2023-05-01
Deactivation Code:
Reactivation Date:2025-12-18
Provider Licenses
StateLicense IDTaxonomies
NY048701-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist