Active NPI
Engracio Gary Villanueva, MD
- Internal Medicine Physician
- Brooklyn, NY
National Provider Identifier
1205899606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 113865
- Practice address
- 3080 Atlantic Ave
Brooklyn, NY 11208 - Phone
- (718) 647-0240
- Fax
- (718) 277-8203
- NPI assigned
- Apr 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 113865 | NY | Primary |
Addresses
Primary practice location
3080 Atlantic Ave
Brooklyn, NY 11208
Mailing address
89-06 135TH St
7L
Jamaica, NY 11418
Phone (718) 206-6984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113865 | NY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JHMC Diagnostic and Treatment Center | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Jamaica, NY
- NPI 1821045485
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438819200000",
"number": "1205899606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "89-06 135TH ST",
"address_2": "7L",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11418",
"telephone_number": "718-206-6984",
"fax_number": "718-206-6786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3080 ATLANTIC AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11208",
"telephone_number": "718-647-0240",
"fax_number": "718-277-8203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLANUEVA",
"first_name": "ENGRACIO",
"middle_name": "GARY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2015-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "113865",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.