Healthcare Provider Details

I. General information

NPI: 1164744132
Provider Name (Legal Business Name): MARIA R. GUERRERO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 OCEAN AVE
BROOKLYN NY
11229-4507
US

IV. Provider business mailing address

160 MIMOSA DR
ROSLYN NY
11576-2235
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4100
  • Fax: 718-615-9335
Mailing address:
  • Phone: 516-621-1852
  • Fax: 877-651-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number193501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: