Healthcare Provider Details

I. General information

NPI: 1558968917
Provider Name (Legal Business Name): DENNIS GUTIERREZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WILLIAMSON AVE
BLOOMFIELD NJ
07003-5004
US

IV. Provider business mailing address

57 WILLIAMSON AVE
BLOOMFIELD NJ
07003-5004
US

V. Phone/Fax

Practice location:
  • Phone: 862-219-9847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DENNIS GUTIERREZ
Title or Position: MEMBER
Credential: PT
Phone: 862-219-9847