1457357535 NPI number — DR. JUAN ANTONIO ANTONIO DE GUZMAN M.D.

Table of content: DR. JUAN ANTONIO ANTONIO DE GUZMAN M.D. (NPI 1457357535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457357535 NPI number — DR. JUAN ANTONIO ANTONIO DE GUZMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE GUZMAN
Provider First Name:
JUAN ANTONIO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE GUZMAN
Provider Other First Name:
JUAN ANTONIO
Provider Other Middle Name:
MANZANILLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457357535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 E. 57TH STREET
Provider Second Line Business Mailing Address:
APT. 29CD.
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-887-0140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E. 77TH STREET
Provider Second Line Business Practice Location Address:
LENOX HILL HOSPITAL, DEPARTMENT OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-434-2878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  179611-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 179611 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 179611 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01814002 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".