Provider Demographics
NPI:1093760662
Name:GAUDERER, ERNST C (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNST
Middle Name:C
Last Name:GAUDERER
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 1:555 NORTH AVE.
Mailing Address - Street 2:APT. 26 S.
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2422
Mailing Address - Country:US
Mailing Address - Phone:201-600-0246
Mailing Address - Fax:
Practice Address - Street 1:555 NORTH AVE
Practice Address - Street 2:APT. 25 S.
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2404
Practice Address - Country:US
Practice Address - Phone:201-600-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071790002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH10053Medicare UPIN
NJ045502Medicare UPIN