Provider Demographics
NPI:1457357535
Name:DE GUZMAN, JUAN ANTONIO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN ANTONIO
Middle Name:ANTONIO
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN ANTONIO
Other - Middle Name:MANZANILLA
Other - Last Name:DE GUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:117 E. 57TH STREET
Mailing Address - Street 2:APT. 29CD.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:917-887-0140
Mailing Address - Fax:
Practice Address - Street 1:100 E. 77TH STREET
Practice Address - Street 2:LENOX HILL HOSPITAL, DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179611-1207L00000X
NY179611208000000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01814002Medicaid
NY01814002Medicaid
E62786Medicare UPIN