Provider Demographics
NPI:1194715516
Name:GAUKLER, CAROLYN JEAN (MD)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:GAUKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 PARKWAY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3018
Mailing Address - Country:US
Mailing Address - Phone:609-883-5454
Mailing Address - Fax:609-883-2565
Practice Address - Street 1:1230 PARKWAY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3018
Practice Address - Country:US
Practice Address - Phone:609-883-5454
Practice Address - Fax:609-883-2565
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044784L207R00000X
NJMA049502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2460904Medicaid
NJ541999 VH6Medicare PIN
NJE58244Medicare UPIN