Healthcare Provider Details

I. General information

NPI: 1710911029
Provider Name (Legal Business Name): STEVEN EVANS GUILLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2549
US

IV. Provider business mailing address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08050600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number232119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: