Provider Demographics
NPI:1881827517
Name:PAUL W. GWOZDZ, M.D., L.L.C.
Entity type:Organization
Organization Name:PAUL W. GWOZDZ, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GWOZDZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-545-4100
Mailing Address - Street 1:710 EASTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1855
Mailing Address - Country:US
Mailing Address - Phone:732-545-4100
Mailing Address - Fax:732-545-4102
Practice Address - Street 1:710 EASTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1855
Practice Address - Country:US
Practice Address - Phone:732-545-4100
Practice Address - Fax:732-545-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8397902Medicaid
NJ8397902Medicaid
NJ042979Medicare PIN