Provider Demographics
NPI:1730134164
Name:DE GUZMAN & DE GUZMAN MEDICAL ASS PA
Entity Type:Organization
Organization Name:DE GUZMAN & DE GUZMAN MEDICAL ASS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-891-3080
Mailing Address - Street 1:688 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3033
Mailing Address - Country:US
Mailing Address - Phone:201-891-3080
Mailing Address - Fax:
Practice Address - Street 1:688 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3033
Practice Address - Country:US
Practice Address - Phone:201-891-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0661309Medicaid
NJ0661309Medicaid
NJ422352Medicare ID - Type Unspecified