Provider Demographics
NPI:1225153927
Name:GARY C. GUERRINO, M.D., P.C.
Entity Type:Organization
Organization Name:GARY C. GUERRINO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GUERRINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-699-0109
Mailing Address - Street 1:400 E SANDFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4725
Mailing Address - Country:US
Mailing Address - Phone:914-699-0109
Mailing Address - Fax:914-699-0385
Practice Address - Street 1:400 E SANDFORD BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4725
Practice Address - Country:US
Practice Address - Phone:914-699-0109
Practice Address - Fax:914-699-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252822Medicaid
NY01252822Medicaid
NYE74452Medicare UPIN
NY01252822Medicaid