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NPI Code Detail

MEDICARE: MARIANA GUDZ MS.SP.ED, MS.ED

MEDICARE:   MARIANA  GUDZ  MS.SP.ED, MS.ED
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
1174400000XSpecialist3011886NY

General Provider Information

NPI Number : 1861150062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANA GUDZ MS.SP.ED, MS.ED
Provider Business Mailing Address
First Line : 45 DALE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-1918
Country : US
Telephone Number : 347-495-5440
Fax Number :
Provider Business Practice Location Address
First Line : 45 DALE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-1918
Country : US
Telephone Number : 347-495-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2021
Last Update Date : 12/04/2021

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