Healthcare Provider Details

I. General information

NPI: 1942297486
Provider Name (Legal Business Name): RAYMOND SAMIR GUINDI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 NORTHFIELD AVE SUITE 200
WEST ORANGE NJ
07052-1174
US

IV. Provider business mailing address

115 SHINNECOCK DR
MANALAPAN NJ
07726-9502
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-9980
  • Fax: 973-736-9981
Mailing address:
  • Phone: 732-896-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMP00091900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: