Bernardo R Villajuan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

115492 Issued in NY

Practice address

319 Broadway
Fort Edward, NY 12828-1221

Phone

(518) 761-0300

Fax

(518) 480-0119

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1033220397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 BROADWAY",
            "city": "FORT EDWARD",
            "state": "NY",
            "postal_code": "128281221",
            "telephone_number": "518-761-0300",
            "fax_number": "518-480-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAJUAN",
        "first_name": "BERNARDO",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "115492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00366569",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Town of Fort Edward Union Free School District
• Rachel Alexandra Truax
• Roseanne Tucker, LCSW
• Barbara Elizabeth Tyler, RN
• Brenda M Van Wie, M.A. C.C.C.-SLP
• Leonard A Waite, RPH
• Washington County Ofa
• Kelly Wheaton
• Wswhe Boces

• Internal Medicine Physician in Fort Edward, NY
• Providers in Fort Edward, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.