MEDICARE: MICHELLE HERNANDEZ GUZMAN

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	207R00000X	Internal Medicine Physician	303136	NY

General Provider Information

NPI Number	:	1386179521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HERNANDEZ GUZMAN

Provider Business Mailing Address
First Line	:	70 GLEN COVE RD STE 306
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1731
Country	:	US
Telephone Number	:	516-621-7720
Fax Number	:	516-625-4521

Provider Business Practice Location Address
First Line	:	70 GLEN COVE RD STE 306
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1731
Country	:	US
Telephone Number	:	516-621-7720
Fax Number	:	166-254-5215

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	09/29/2023

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Directions to “ MICHELLE HERNANDEZ GUZMAN ” Practice Location

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