Provider Demographics
NPI:1043479595
Name:BAUZA, GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:BAUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 RICHMOND ST
Mailing Address - Street 2:APT 4106
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4100
Mailing Address - Country:US
Mailing Address - Phone:787-948-8262
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON STREET SUITE 6300
Practice Address - Street 2:ROBERT WOOD JOHNSON MEDICAL SCHOOL DIVISION OF ACS
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA098628002086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09862800OtherNEW JERSEY MEDICAL LICENSE
MA249589OtherMASSACHUSETTS MEDICAL LICENSE