Healthcare Provider Details

I. General information

NPI: 1194474353
Provider Name (Legal Business Name): ROHIVERTH GUARECUCO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

1750 WASHINGTON ST APT 10
BOSTON MA
02118-1831
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number340870
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number340870
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number340870
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number340870
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number340870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: