Provider Demographics
NPI:1396719845
Name:GUDIS, STEVEN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:GUDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 CENTER GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4453
Mailing Address - Country:US
Mailing Address - Phone:973-361-3737
Mailing Address - Fax:973-361-9884
Practice Address - Street 1:121 CENTER GROVE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4453
Practice Address - Country:US
Practice Address - Phone:973-361-3737
Practice Address - Fax:973-361-9884
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40534207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110140753OtherPALMETTO GBA RAILROAD ME
27083OtherAETNA
5711248OtherMULTIPLAN
NJ3656OtherHEALTHNET
IP005OtherOXFORD
NJ085420401Medicaid
222306589003OtherQUALCARE
27083OtherAETNA
NJ085420401Medicaid