Healthcare Provider Details

I. General information

NPI: 1629680962
Provider Name (Legal Business Name): MANUELA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FARRINGTON ST
VAUXHALL NJ
07088-1307
US

IV. Provider business mailing address

3 FARRINGTON ST
VAUXHALL NJ
07088-1307
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-4944
  • Fax: 973-763-4955
Mailing address:
  • Phone: 973-762-4944
  • Fax: 973-763-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: