Healthcare Provider Details

I. General information

NPI: 1306636238
Provider Name (Legal Business Name): MARC EDWARD GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 13
HILLSDALE NJ
07642-0013
US

IV. Provider business mailing address

PO BOX 13
HILLSDALE NJ
07642-0013
US

V. Phone/Fax

Practice location:
  • Phone: 215-407-1312
  • Fax:
Mailing address:
  • Phone: 215-407-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00946000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: