Healthcare Provider Details

I. General information

NPI: 1790146553
Provider Name (Legal Business Name): JAVIER GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 N HARTFORD AVE
ATLANTIC CITY NJ
08401-3512
US

IV. Provider business mailing address

6550 DELILAH RD STE 301
EGG HARBOR TOWNSHIP NJ
08234-5102
US

V. Phone/Fax

Practice location:
  • Phone: 609-348-1161
  • Fax: 609-645-7343
Mailing address:
  • Phone: 609-272-8580
  • Fax: 609-645-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: