Healthcare Provider Details

I. General information

NPI: 1982697033
Provider Name (Legal Business Name): PAUL NEIL GUERRIERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2185
US

IV. Provider business mailing address

9 CHATEAU RIDGE DR
GREENWICH CT
06831-2940
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-7272
  • Fax:
Mailing address:
  • Phone: 203-861-0708
  • Fax: 203-861-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number158997
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number031410
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25MA05393900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: