MEDICARE: DR. JOAQUIN C GUTIERREZ JR. M.D.

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
1	207Q00000X	Family Medicine Physician	161519	NY

General Provider Information

NPI Number	:	1619110707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAQUIN C GUTIERREZ JR. M.D.

Provider Business Mailing Address
First Line	:	124 GETZ AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2114
Country	:	US
Telephone Number	:	718-967-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 GETZ AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2114
Country	:	US
Telephone Number	:	718-967-2902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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