MEDICARE: DR. RODOLFO GUZMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	183600	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134137839	OTHER	NY	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205867835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODOLFO GUZMAN M.D.

Provider Business Mailing Address
First Line	:	860 GRAND CONCOURSE
Second Line	:	SUITE 1K
City	:	BRONX
State	:	NY
Zip	:	10451-2814
Country	:	US
Telephone Number	:	718-585-5060
Fax Number	:	718-585-4866

Provider Business Practice Location Address
First Line	:	860 GRAND CONCOURSE
Second Line	:	SUITE 1K
City	:	BRONX
State	:	NY
Zip	:	10451-2821
Country	:	US
Telephone Number	:	718-585-5060
Fax Number	:	718-585-4866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/07/2023

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