1720135593 NPI number — MRS. JILL GUZMAN APN NURSE PRACTITION

Table of content: MRS. JILL GUZMAN APN NURSE PRACTITION (NPI 1720135593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720135593 NPI number — MRS. JILL GUZMAN APN NURSE PRACTITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
JILL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN NURSE PRACTITION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANTANA
Provider Other First Name:
JILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720135593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 ANDOVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST NEW YORK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-866-9320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

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: 363LP0200X , with the licence number:  NN111636 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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