Provider Demographics
NPI:1205974359
Name:GUBERNICK, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:GUBERNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 PRINCETON PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3221
Mailing Address - Country:US
Mailing Address - Phone:609-538-8331
Mailing Address - Fax:
Practice Address - Street 1:1125 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-5801
Practice Address - Country:US
Practice Address - Phone:609-393-3017
Practice Address - Fax:609-396-3459
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02035900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist