Healthcare Provider Details

I. General information

NPI: 1043479595
Provider Name (Legal Business Name): GUSTAVO BAUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON STREET SUITE 6300 ROBERT WOOD JOHNSON MEDICAL SCHOOL DIVISION OF ACS
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

1 RICHMOND ST APT 4106
NEW BRUNSWICK NJ
08901-4100
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7766
  • Fax:
Mailing address:
  • Phone: 787-948-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA09862800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09862800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: