Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00725300 | NJ |
NPI | 1407243900 |
---|---|
Provider Name | Dr. Guy Guerriero |
First Address | Ridgewood, NJ 07450-1409 |
Second Address | Ridgewood, NJ 07450-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 22/04/2015 |