Provider Demographics
NPI:1205867835
Name:GUZMAN, RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2814
Mailing Address - Country:US
Mailing Address - Phone:718-585-5060
Mailing Address - Fax:718-585-4866
Practice Address - Street 1:860 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2821
Practice Address - Country:US
Practice Address - Phone:718-585-5060
Practice Address - Fax:718-585-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183600207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134137839OtherTAX ID
NY01370974Medicaid
NYBG2465284OtherDEA
NYF26406Medicare UPIN
NY40K661Medicare ID - Type Unspecified