Provider Demographics
NPI:1467520239
Name:GAUDINO, SILVANA (MD)
Entity Type:Individual
Prefix:
First Name:SILVANA
Middle Name:
Last Name:GAUDINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTH FULLERTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3412
Mailing Address - Country:US
Mailing Address - Phone:973-744-2226
Mailing Address - Fax:973-509-0978
Practice Address - Street 1:127 PINE ST STE 10
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4869
Practice Address - Country:US
Practice Address - Phone:973-707-2122
Practice Address - Fax:973-655-9559
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04978100207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3089606Medicaid
NJ3089606Medicaid
NJE23743Medicare UPIN