Healthcare Provider Details

I. General information

NPI: 1679199731
Provider Name (Legal Business Name): LAURA M GUZMAN PEREZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date: 01/17/2022
Reactivation Date: 03/01/2022

III. Provider practice location address

3201 KINGS HIGHWAY
BROOKLYN NY
11234
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1264
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number336864
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number336864
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number336864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: