Provider Demographics
NPI:1609843762
Name:GUILIANO, PHILIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:GUILIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:23659 COLUMBUS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1980
Mailing Address - Country:US
Mailing Address - Phone:609-298-3304
Mailing Address - Fax:609-298-7091
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1979
Practice Address - Country:US
Practice Address - Phone:609-298-3304
Practice Address - Fax:609-298-7091
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04161800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1329201Medicaid
NJ080082A14Medicare ID - Type Unspecified
NJ1329201Medicaid