Healthcare Provider Details

I. General information

NPI: 1164746319
Provider Name (Legal Business Name): BLAIR J. GUIDERA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 JERICHO TPKE
JERICHO NY
11753-1013
US

IV. Provider business mailing address

305 E 40TH ST APT 2L
NEW YORK NY
10016-2189
US

V. Phone/Fax

Practice location:
  • Phone: 516-338-0505
  • Fax: 516-338-4378
Mailing address:
  • Phone: 516-338-0505
  • Fax: 516-338-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAIR JESSUP GUIDERA
Title or Position: OWNER
Credential: MD
Phone: 516-338-0505