Provider Demographics
NPI:1679560833
Name:GUZMAN, ELISCER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISCER
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-0837
Mailing Address - Country:US
Mailing Address - Phone:718-562-6570
Mailing Address - Fax:718-364-5313
Practice Address - Street 1:629 W 185TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:212-781-9223
Practice Address - Fax:212-781-0513
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161145207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2285021OtherECFMG
NY00947860Medicaid
NY00947860Medicaid
NY2285021OtherECFMG