Provider Demographics
NPI:1043293624
Name:GAMBURG, EUGENE SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:SAMUEL
Last Name:GAMBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PRINCESS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2320
Mailing Address - Country:US
Mailing Address - Phone:609-896-0777
Mailing Address - Fax:609-896-3266
Practice Address - Street 1:2 PRINCESS RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2320
Practice Address - Country:US
Practice Address - Phone:609-896-0777
Practice Address - Fax:609-896-3266
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07437400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066779S3ZMedicare PIN
NJH77791Medicare UPIN