Healthcare Provider Details

I. General information

NPI: 1144282450
Provider Name (Legal Business Name): VIRGINIA DEGUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WYCKOFF AVE DEGUZMAN & DEGUZMAN
MAHWAH NJ
07430-3035
US

IV. Provider business mailing address

608 WYCKOFF AVE DEGUZMAN & DEGUZMAN
MAHWAH NJ
07430-3035
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-3080
  • Fax: 201-847-0995
Mailing address:
  • Phone: 201-891-3080
  • Fax: 201-847-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA041083
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: