Provider Demographics
NPI:1225654486
Name:NILSA S GUTIERREZ MD PLLC
Entity Type:Organization
Organization Name:NILSA S GUTIERREZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:SOCORRO
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-679-2993
Mailing Address - Street 1:702 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1611
Mailing Address - Country:US
Mailing Address - Phone:201-679-2993
Mailing Address - Fax:
Practice Address - Street 1:1045 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1206
Practice Address - Country:US
Practice Address - Phone:201-679-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty