Healthcare Provider Details

I. General information

NPI: 1619568375
Provider Name (Legal Business Name): EDWIN GUZMAN CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0293
  • Fax: 212-305-9058
Mailing address:
  • Phone: 212-305-0293
  • Fax: 212-305-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: