Provider Demographics
NPI:1205010931
Name:LUIS E GUERRERO, MD, PC
Entity Type:Organization
Organization Name:LUIS E GUERRERO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-299-2100
Mailing Address - Street 1:1216 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4755
Mailing Address - Country:US
Mailing Address - Phone:718-597-1107
Mailing Address - Fax:718-597-8567
Practice Address - Street 1:1216 BEACH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4755
Practice Address - Country:US
Practice Address - Phone:718-597-1107
Practice Address - Fax:718-597-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166025207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
166025OtherLICENSE
NY00951051Medicaid
NY00951051Medicaid
NY00951051Medicaid
NY68D151Medicare PIN