Healthcare Provider Details

I. General information

NPI: 1285677427
Provider Name (Legal Business Name): VINCENT C GUIDA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 WEST BAY AVENUE
BARNEGAT NJ
08005
US

IV. Provider business mailing address

849 WEST BAY AVENUE
BARNEGAT NJ
08005
US

V. Phone/Fax

Practice location:
  • Phone: 609-660-0900
  • Fax: 609-660-1118
Mailing address:
  • Phone: 609-660-0900
  • Fax: 609-660-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB06113500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNJMB06113500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: