Provider Demographics
NPI:1407144959
Name:GUZMAN, BERNARD (CP)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3931
Mailing Address - Country:US
Mailing Address - Phone:516-681-3484
Mailing Address - Fax:516-681-3406
Practice Address - Street 1:132 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3931
Practice Address - Country:US
Practice Address - Phone:516-681-3484
Practice Address - Fax:516-681-3406
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2748335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier