Healthcare Provider Details

I. General information

NPI: 1487395661
Provider Name (Legal Business Name): CHRISTIAN MIGUEL GONZALEZ QUINONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND STREET DEPARTMENT OF MEDICINE 1 EAST
JERSEY CITY NJ
07302
US

IV. Provider business mailing address

355 GRAND STREET DEPARTMENT OF MEDICINE 1 EAST
JERSEY CITY NJ
07302
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2431
  • Fax: 201-915-2219
Mailing address:
  • Phone: 201-915-2431
  • Fax: 201-915-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number024853
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: