Provider Demographics
NPI:1871739128
Name:VILLARRAGA, ANNEMARIE L (PAC)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:L
Last Name:VILLARRAGA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48310
Mailing Address - Street 2:EMERGENCY PHYSICIANS OF EMA
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8510
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-7575
Practice Address - Fax:845-333-1454
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY019726363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical