Provider Demographics
NPI:1689659302
Name:MAGUINA, JUAN E (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:E
Last Name:MAGUINA
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 1:1779 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3907
Mailing Address - Country:US
Mailing Address - Phone:718-982-6800
Mailing Address - Fax:718-982-6830
Practice Address - Street 1:1779 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3907
Practice Address - Country:US
Practice Address - Phone:718-982-6800
Practice Address - Fax:718-982-6830
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219130208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03120101Medicaid
NY02227943Medicaid
NY03120101Medicaid
NY5B7041Medicare ID - Type Unspecified