Provider Demographics
NPI:1922110196
Name:NARVAEZ, GUILLERMO PUNZALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:PUNZALAN
Last Name:NARVAEZ
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 1:21 THEYKEN PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2935
Mailing Address - Country:US
Mailing Address - Phone:201-445-6108
Mailing Address - Fax:201-445-6510
Practice Address - Street 1:135 BLOOMFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:973-743-3556
Practice Address - Fax:973-743-3895
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04619500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3974201Medicaid
NJ3974201Medicaid
NJE13256Medicare UPIN