=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962163659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUKE GUIZLO PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2022
-----------------------------------------------------
Last Update Date | 05/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MUNRO AVE
-----------------------------------------------------
City | CAPE MAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08204-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-898-6959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 MUNRO AVE
-----------------------------------------------------
City | CAPE MAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08204-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1100X
-----------------------------------------------------
Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00796300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------