Provider Demographics
NPI:1811981194
Name:GUERRINO, GARY CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHRISTOPHER
Last Name:GUERRINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 E SANDFORD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4725
Mailing Address - Country:US
Mailing Address - Phone:914-699-0109
Mailing Address - Fax:914-699-0385
Practice Address - Street 1:400 E SANDFORD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4725
Practice Address - Country:US
Practice Address - Phone:914-699-0109
Practice Address - Fax:914-699-0385
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181694-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252822Medicaid
NY134045112OtherFEDERAL TAX I.D. #
NYE74452Medicare UPIN
NY01252822Medicaid