Provider Demographics
NPI:1447364922
Name:VILORIA, EDMERMIRO (MD,)
Entity type:Individual
Prefix:
First Name:EDMERMIRO
Middle Name:
Last Name:VILORIA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3324
Mailing Address - Country:US
Mailing Address - Phone:201-433-6500
Mailing Address - Fax:
Practice Address - Street 1:679 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3324
Practice Address - Country:US
Practice Address - Phone:201-433-6500
Practice Address - Fax:201-433-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162994207R00000X
NJ25MA04463300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0264962Medicaid
NY06F671OtherMEDICARE-INDIVIDUAL
NJ442743MVHOtherMEDICARE-NJ
NY01551688Medicaid
NJ442743MVHOtherMEDICARE-NJ