Provider Demographics
NPI:1437404993
Name:GUTTMAN, JILL (MS ED)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GUTTMAN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5078
Mailing Address - Country:US
Mailing Address - Phone:516-931-1114
Mailing Address - Fax:
Practice Address - Street 1:555 BROADHOLLOW ROAD, SUITE 102
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-6802
Practice Address - Country:US
Practice Address - Phone:516-931-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2020-02-06
Deactivation Date:2016-10-10
Deactivation Code:
Reactivation Date:2020-02-06
Provider Licenses
StateLicense IDTaxonomies
NY1056977161174400000X
NY1056815161174400000X
NY223078081174400000X
NY258630081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty