Healthcare Provider Details

I. General information

NPI: 1679560833
Provider Name (Legal Business Name): ELISCER GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 W 185TH ST 2ND FLOOR
NEW YORK NY
10033-3102
US

IV. Provider business mailing address

PO BOX 837
HARTSDALE NY
10530-0837
US

V. Phone/Fax

Practice location:
  • Phone: 212-781-9223
  • Fax: 212-781-0513
Mailing address:
  • Phone: 718-562-6570
  • Fax: 718-364-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number161145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: