Provider Demographics
NPI:1770375230
Name:VILLANUEVA, NELSON ANGELO BALLESTEROS (PA-C)
Entity type:Individual
Prefix:
First Name:NELSON ANGELO
Middle Name:BALLESTEROS
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 OAK ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3828
Mailing Address - Country:US
Mailing Address - Phone:201-888-0741
Mailing Address - Fax:
Practice Address - Street 1:381 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4069
Practice Address - Country:US
Practice Address - Phone:201-366-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP009301002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine