MEDICARE: DR. ERNST C GAUDERER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA07179000	NJ

General Provider Information

NPI Number	:	1093760662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNST C GAUDERER MD

Provider Business Mailing Address
First Line	:	555 NORTH AVE.
Second Line	:	APT. 26 S.
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2422
Country	:	US
Telephone Number	:	201-600-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 NORTH AVE
Second Line	:	APT. 25 S.
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2404
Country	:	US
Telephone Number	:	201-600-0246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/09/2009

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