Provider Demographics
NPI:1407325327
Name:GUIDICE, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:GUIDICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARTER PL
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1604
Mailing Address - Country:US
Mailing Address - Phone:908-268-0798
Mailing Address - Fax:
Practice Address - Street 1:6 CARTER PL
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1604
Practice Address - Country:US
Practice Address - Phone:908-268-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1280601181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist