Provider Demographics
NPI:1245372713
Name:GUAGLIARDO, STEVEN F (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:F
Last Name:GUAGLIARDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 NEW DORP PLAZA
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2904
Mailing Address - Country:US
Mailing Address - Phone:718-980-4840
Mailing Address - Fax:718-980-4841
Practice Address - Street 1:86 NEW DORP PLAZA
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2904
Practice Address - Country:US
Practice Address - Phone:718-980-4840
Practice Address - Fax:718-980-4841
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7586-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX14771Medicare ID - Type Unspecified