Provider Demographics
NPI:1861430076
Name:GUILLEN, RAFAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 GRAND CONCOURSE FRNT OFFICE5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3003
Mailing Address - Country:US
Mailing Address - Phone:718-401-2300
Mailing Address - Fax:718-401-2322
Practice Address - Street 1:800 GRAND CONCOURSE FRNT OFFICE5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3003
Practice Address - Country:US
Practice Address - Phone:718-401-2300
Practice Address - Fax:718-401-2322
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2020-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY233234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI25984Medicare UPIN