Provider Demographics
NPI:1922265446
Name:GUTIERREZ, NILSA SOCORRO (MD)
Entity Type:Individual
Prefix:DR
First Name:NILSA
Middle Name:SOCORRO
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1611
Mailing Address - Country:US
Mailing Address - Phone:201-928-1208
Mailing Address - Fax:
Practice Address - Street 1:1045 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1206
Practice Address - Country:US
Practice Address - Phone:201-679-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine