Provider Demographics
NPI:1811632003
Name:GUO, JINYIR
Entity type:Individual
Prefix:
First Name:JINYIR
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 OLD POST RD STE 6
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4684
Mailing Address - Country:US
Mailing Address - Phone:732-287-3999
Mailing Address - Fax:732-579-6659
Practice Address - Street 1:511 OLD POST RD STE 6
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4684
Practice Address - Country:US
Practice Address - Phone:732-287-3999
Practice Address - Fax:732-579-6659
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02357000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7155808Medicaid