Healthcare Provider Details

I. General information

NPI: 1548185135
Provider Name (Legal Business Name): JUSTINA GUT DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BEACH AVE
STATEN ISLAND NY
10306-1915
US

IV. Provider business mailing address

28 BEACH AVE
STATEN ISLAND NY
10306-1915
US

V. Phone/Fax

Practice location:
  • Phone: 347-370-2205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359886-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: