Provider Demographics
NPI:1144751207
Name:GUZMAN, NOHORA
Entity Type:Individual
Prefix:
First Name:NOHORA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 CENTER BLVD
Mailing Address - Street 2:APT 309
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5792
Mailing Address - Country:US
Mailing Address - Phone:917-319-7201
Mailing Address - Fax:
Practice Address - Street 1:4540 CENTER BLVD
Practice Address - Street 2:APT 309
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5792
Practice Address - Country:US
Practice Address - Phone:917-319-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021119-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist