Healthcare Provider Details

I. General information

NPI: 1447171913
Provider Name (Legal Business Name): NAOMI BETH GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NAOMI PANZER

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MOUNTAIN AVE
SPRINGFIELD NJ
07081-3463
US

IV. Provider business mailing address

6 SAKS CT
SPRINGFIELD NJ
07081-1075
US

V. Phone/Fax

Practice location:
  • Phone: 201-540-9777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00981200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: