Provider Demographics
NPI:1518052950
Name:GREGORIO J. GUILLEN MD, PC
Entity Type:Organization
Organization Name:GREGORIO J. GUILLEN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-442-6020
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08862-1068
Mailing Address - Country:US
Mailing Address - Phone:732-442-6020
Mailing Address - Fax:732-442-1995
Practice Address - Street 1:400 STATE ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861
Practice Address - Country:US
Practice Address - Phone:732-442-6020
Practice Address - Fax:732-442-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6523706Medicaid
NJ71642Medicare ID - Type Unspecified
NJF28350Medicare UPIN