Healthcare Provider Details

I. General information

NPI: 1265349674
Provider Name (Legal Business Name): NOELLE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 THE PROMENADE SPC A3B
EDGEWATER NJ
07020-2126
US

IV. Provider business mailing address

19 THE PROMENADE SPC A3B
EDGEWATER NJ
07020-2126
US

V. Phone/Fax

Practice location:
  • Phone: 201-377-1510
  • Fax: 201-377-2151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02433700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: