1669681045 NPI number — MRS. GLENNIS NAOMI EDWARDS-GUISHARD PHYSICIAN ASSISTANT

Table of content: MRS. GLENNIS NAOMI EDWARDS-GUISHARD PHYSICIAN ASSISTANT (NPI 1669681045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669681045 NPI number — MRS. GLENNIS NAOMI EDWARDS-GUISHARD PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS-GUISHARD
Provider First Name:
GLENNIS
Provider Middle Name:
NAOMI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDWARDS-GUISHARD
Provider Other First Name:
GLENNIS
Provider Other Middle Name:
NAOMI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669681045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
964 E 179TH ST
Provider Second Line Business Mailing Address:
PRIVATE BOX 7
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10460-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-223-7730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16TH STREET 1ST AVENUE
Provider Second Line Business Practice Location Address:
9 BERNSTEIN
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-2969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

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: 363AM0700X , with the licence number:  006478 , 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)





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