Healthcare Provider Details

I. General information

NPI: 1154908952
Provider Name (Legal Business Name): JENIEVE DELACRUZ GUEVARRA MD, MBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 MAMARONECK AVE
WHITE PLAINS NY
10605-2523
US

IV. Provider business mailing address

785 MAMARONECK AVE
WHITE PLAINS NY
10605-2523
US

V. Phone/Fax

Practice location:
  • Phone: 914-597-2500
  • Fax: 914-597-2760
Mailing address:
  • Phone: 914-597-2500
  • Fax: 914-597-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number343797-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA12680400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: