Provider Demographics
NPI:1750380572
Name:GUARRACINI, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUARRACINI
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 1:9W ROUTE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993
Mailing Address - Country:US
Mailing Address - Phone:845-786-4062
Mailing Address - Fax:845-786-4526
Practice Address - Street 1:51 N ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1127
Practice Address - Country:US
Practice Address - Phone:845-786-4101
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163039208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF20754Medicare UPIN