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General NPI Number Information
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NPI Number | 1043479595
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Entity Type | Individual
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Provider Name | GUSTAVO BAUZA MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 125 PATERSON STREET SUITE 6300 ROBERT WOOD JOHNSON MEDICAL SCHOOL DIVISION OF ACS
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901
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Country | US
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Telephone | 732-235-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RICHMOND ST APT 4106
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-4100
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Country | US
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Telephone | 787-948-8262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 25MA09862800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA09862800
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License Number State | NJ
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