Provider Demographics
NPI:1629680962
Name:GUZMAN, MANUELA
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:GUZMAN
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 1:3 FARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1307
Mailing Address - Country:US
Mailing Address - Phone:973-762-4944
Mailing Address - Fax:973-763-4955
Practice Address - Street 1:3 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1307
Practice Address - Country:US
Practice Address - Phone:973-762-4944
Practice Address - Fax:973-763-4955
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG95215160060922OtherDRIVER'S LICENSE