1912999301 NPI number — DR. GUILLERMO GUTIERREZ MD

Table of content: DR. GUILLERMO GUTIERREZ MD (NPI 1912999301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912999301 NPI number — DR. GUILLERMO GUTIERREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
GUILLERMO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912999301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-8470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-818-9118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 NEW BRUNSWICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-324-6031
Provider Business Practice Location Address Fax Number:
732-324-4811
Provider Enumeration Date:
08/22/2005

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: 208600000X , with the licence number:  25MA05749600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 25MA05749600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2490711000 . This is a "AMERIHEALTH ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 271940 . This is a "AMERIGROUP ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8220018 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00211038 . This is a "RAILROAD MEDICARE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60012743 . This is a "HORIZON NJ HEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 39302 . This is a "UHP ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K3773 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com