Provider Demographics
NPI:1720184104
Name:GUILLERMETY, ESPERANZA (MD)
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:
Last Name:GUILLERMETY
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 1:79 BAYARD LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3045
Mailing Address - Country:US
Mailing Address - Phone:609-497-3034
Mailing Address - Fax:609-497-3030
Practice Address - Street 1:79 BAYARD LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3045
Practice Address - Country:US
Practice Address - Phone:609-497-3034
Practice Address - Fax:609-497-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53366208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4013107Medicaid
NJA28681Medicare UPIN
NJ577278Medicare ID - Type Unspecified