MEDICARE: EISON DE GUZMAN MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942839667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EISON DE GUZMAN MD

Provider Business Mailing Address
First Line	:	185 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	973-972-4731
Fax Number	:

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

Provider Enumeration Date	:	04/04/2020
Last Update Date	:	03/14/2026

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Directions to “ EISON DE GUZMAN MD” Practice Location

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