Healthcare Provider Details

I. General information

NPI: 1871041772
Provider Name (Legal Business Name): SVETLANA GUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 RETNER ST
STATEN ISLAND NY
10305-4566
US

IV. Provider business mailing address

107 RETNER ST
STATEN ISLAND NY
10305-4566
US

V. Phone/Fax

Practice location:
  • Phone: 646-287-8699
  • Fax:
Mailing address:
  • Phone: 646-287-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number619439-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: