Provider Demographics
NPI:1164746319
Name:BLAIR J. GUIDERA, PC
Entity Type:Organization
Organization Name:BLAIR J. GUIDERA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:JESSUP
Authorized Official - Last Name:GUIDERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-338-0505
Mailing Address - Street 1:305 E 40TH ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2189
Mailing Address - Country:US
Mailing Address - Phone:516-338-0505
Mailing Address - Fax:516-338-4378
Practice Address - Street 1:55 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1013
Practice Address - Country:US
Practice Address - Phone:516-338-0505
Practice Address - Fax:516-338-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty