Provider Demographics
NPI:1659433647
Name:GUILLORY, SAMUEL LESTER (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LESTER
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:L
Other - Last Name:GUILLORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 E 89TH ST
Mailing Address - Street 2:APT. 35C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4300
Mailing Address - Country:US
Mailing Address - Phone:212-860-5400
Mailing Address - Fax:
Practice Address - Street 1:1103 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-860-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127306207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology