Healthcare Provider Details

I. General information

NPI: 1497832133
Provider Name (Legal Business Name): CRAIG GUERIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2559
US

IV. Provider business mailing address

675 SACKETT ST APT 203
BROOKLYN NY
11217-3126
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-8866
  • Fax:
Mailing address:
  • Phone: 718-636-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: