Provider Demographics
NPI:1679830798
Name:GUERRA, ALLAN (NP)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RAIDER BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1528
Mailing Address - Country:US
Mailing Address - Phone:908-281-0221
Mailing Address - Fax:908-281-0940
Practice Address - Street 1:211 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1031
Practice Address - Country:US
Practice Address - Phone:732-222-4762
Practice Address - Fax:732-222-4764
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00365400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0290785Medicaid