Provider Demographics
NPI:1235191438
Name:GUADARA, JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GUADARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:201-847-2044
Mailing Address - Fax:
Practice Address - Street 1:24 BERGEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5482
Practice Address - Country:US
Practice Address - Phone:201-488-8599
Practice Address - Fax:201-488-4953
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2052213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5008204Medicaid
U19039Medicare UPIN
NJGU679001026370Medicare ID - Type Unspecified