Healthcare Provider Details

I. General information

NPI: 1346280336
Provider Name (Legal Business Name): ALEXANDER GUDZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 IRVINGTON AVE
MAPLEWOOD NJ
07040-1607
US

IV. Provider business mailing address

14 SANDALWOOD DR
LIVINGSTON NJ
07039-1409
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-6033
  • Fax: 973-762-6088
Mailing address:
  • Phone: 973-758-9459
  • Fax: 973-758-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA07860000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number231198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: