Healthcare Provider Details

I. General information

NPI: 1730134164
Provider Name (Legal Business Name): DE GUZMAN & DE GUZMAN MEDICAL ASS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 WYCKOFF AVE
MAHWAH NJ
07430-3033
US

IV. Provider business mailing address

688 WYCKOFF AVE
MAHWAH NJ
07430-3033
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-3080
  • Fax:
Mailing address:
  • Phone: 201-891-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA41855
License Number StateNJ

VIII. Authorized Official

Name: DR. FRANCISCO DEGUZMAN
Title or Position: OWNER
Credential: MD
Phone: 201-891-3080