MEDICARE: CARMEN M GONZALEZ R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	440104-1	NY

General Provider Information

NPI Number	:	1043576135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN M GONZALEZ R.N.

Provider Business Mailing Address
First Line	:	1440 STORY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4909
Country	:	US
Telephone Number	:	718-860-5060
Fax Number	:	718-860-5100

Provider Business Practice Location Address
First Line	:	1440 STORY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4909
Country	:	US
Telephone Number	:	718-860-5060
Fax Number	:	718-860-5100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	04/24/2012

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