MEDICARE: ALEXANDER GUDZ LLC

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1609124890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER GUDZ LLC

Provider Business Mailing Address
First Line	:	62 MAIN AVE
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-1134
Country	:	US
Telephone Number	:	973-986-5576
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 MAIN AVE
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-1134
Country	:	US
Telephone Number	:	973-986-5576
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER GUDZ
Credential	:	MD
Telephone Number	:	973-997-1100

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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