Active NPI
Yanick Guerin, DO
- Pediatrics Physician
- East Orange, NJ
National Provider Identifier
1619912987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 235958
- Practice address
- 344 S Harrison St
East Orange, NJ 07018-1235 - Phone
- (973) 674-8373
- NPI assigned
- Jun 19, 2006
- Last updated
- Oct 2, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MB77416 | NJ | |
| Pediatrics Physician | 208000000X | 235958 | NY | Primary |
Addresses
Primary practice location
344 S Harrison St
East Orange, NJ 07018-1235
Mailing address
PO Box 3067
East Orange, NJ 07019-3067
Phone (973) 674-8373
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0078654 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MB77416 | NJ | MD | Specialist |
| 235958 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Pediatrics | Current | Accepting new patients |
| Montefiore Medical Center | Current | Accepting new patients | |
| Foundation Pediatrics | Specialist | Past | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
925 Astor Ave
Bronx, NY 10469
Phone (718) 293-9569
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- yguerin@montefioredirect.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Montefiore Community Pharmacy @ CHAM
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443744000000",
"number": "1619912987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3067",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070193067",
"telephone_number": "973-674-8373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 S HARRISON ST",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070181235",
"telephone_number": "973-674-8373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUERIN",
"first_name": "YANICK",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-19",
"last_updated": "2015-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NJ",
"license": "MB77416",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "235958",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0078654",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.