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NPI Code Detail

MEDICARE: JACQUELINE GUTERMAN MD, PHD

MEDICARE:   JACQUELINE  GUTERMAN  MD, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207V00000XObstetrics & Gynecology Physician287666NY

General Provider Information

NPI Number : 1225371354
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE GUTERMAN MD, PHD
Provider Business Mailing Address
First Line : 24 DOROTHY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314
Country : US
Telephone Number : 917-679-8787
Fax Number :
Provider Business Practice Location Address
First Line : 78 CROMWELL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10304-3912
Country : US
Telephone Number : 718-987-9175
Fax Number : 718-987-1322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2013
Last Update Date : 03/17/2018

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Directions to “ JACQUELINE GUTERMAN MD, PHD” Practice Location

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