Healthcare Provider Details

I. General information

NPI: 1821223041
Provider Name (Legal Business Name): MARCELLO GUGLIELMI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 GRAND COUNCOURSE, 6 TH FLOOR BRONX-LEBANON HOSPITAL CENTER
NEW YORK NY
10453
US

IV. Provider business mailing address

1775 GRAND CONCOURSE BRONX-LEBANON HOSPITAL CENTER
BRONX NY
10453-8202
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-2162
  • Fax:
Mailing address:
  • Phone: 216-903-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number056946-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: