Healthcare Provider Details

I. General information

NPI: 1548459720
Provider Name (Legal Business Name): FRANK JOSEPH GAUDIANO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CLINTON ST
CAMDEN NJ
08103-3529
US

IV. Provider business mailing address

439 CLINTON ST
CAMDEN NJ
08103-3529
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3865
  • Fax:
Mailing address:
  • Phone: 856-757-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA03518100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: