Provider Demographics
NPI:1588659775
Name:GUO, JENNY P (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:P
Last Name:GUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PEOPLES LINE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7366
Mailing Address - Country:US
Mailing Address - Phone:347-951-9393
Mailing Address - Fax:718-989-3131
Practice Address - Street 1:140 MEISNER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1236
Practice Address - Country:US
Practice Address - Phone:347-951-9393
Practice Address - Fax:718-989-3131
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635385Medicaid
NY203AB1Medicare PIN
NYI00155Medicare UPIN