Basic Information
Provider Information
NPI: 1255912523
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUZMAN
FirstName: JANET
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 CRYSTAL RUN RD
Address2:  
City: MIDDLETOWN
State: NY
PostalCode: 109414028
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Practice Location
Address1: 1200 ROUTE 300
Address2:  
City: NEWBURGH
State: NY
PostalCode: 125505003
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Other Information
ProviderEnumerationDate: 04/19/2021
LastUpdateDate: 06/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XF347601NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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