Provider Demographics
NPI:1285677427
Name:GUIDA, VINCENT C (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:C
Last Name:GUIDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 WEST BAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005
Mailing Address - Country:US
Mailing Address - Phone:609-660-0900
Mailing Address - Fax:609-660-1118
Practice Address - Street 1:849 WEST BAY AVENUE
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005
Practice Address - Country:US
Practice Address - Phone:609-660-0900
Practice Address - Fax:609-660-1118
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06113500207R00000X
NJNJMB06113500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8340501Medicaid
NJ8340501Medicaid
NJ041955Medicare PIN
NJG32798Medicare UPIN