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General NPI Number Information
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NPI Number | 1164746319
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Entity Type | Organization
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Legal Business Name | BLAIR J. GUIDERA, PC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 55 JERICHO TPKE
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City | JERICHO
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State | NY
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Zip | 11753-1013
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Country | US
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Telephone | 516-338-0505
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Fax | 516-338-4378
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Provider Business Mailing Address
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Address Line | 305 E 40TH ST APT 2L
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City | NEW YORK
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State | NY
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Zip | 10016-2189
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Country | US
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Telephone | 516-338-0505
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Fax | 516-338-4378
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAIR JESSUP GUIDERA
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Credential | MD
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Telephone | 516-338-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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