Provider Demographics
NPI:1700913886
Name:GUIDERA, BLAIR JESSUP (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:JESSUP
Last Name:GUIDERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:305 EAST 40TH STREET
Mailing Address - Street 2:APT 2L
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 E 38TH ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2660
Practice Address - Country:US
Practice Address - Phone:212-490-2446
Practice Address - Fax:212-599-2376
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics