Mediavillo, Rene S

Mediavillo, Rene S is an individual health care provider with primary practice located at 9202 Liberty Ave , Ozone Park NY 11417-1526. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Mediavillo, Rene S can be contacted via phone (718) 835-9729.

Contact Information

Primary practice address
9202 Liberty Ave Ozone Park NY 11417-1526
Phone: (718) 835-9729
Fax: (718) 925-9817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 136585 New York

Profile Details

NPI number 1376622019
LBN Legal business name Mediavillo, Rene S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376622019 NPPES
New York Other 136585 LICENSE
New York MEDICAID 00589464 LICENSE

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