Healthcare Provider Details

I. General information

NPI: 1518954882
Provider Name (Legal Business Name): FRANCISCO D GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 38TH ST
UNION CITY NJ
07087-4995
US

IV. Provider business mailing address

PO BOX 4804
WEEHAWKEN NJ
07086-7801
US

V. Phone/Fax

Practice location:
  • Phone: 201-325-9009
  • Fax: 201-223-4880
Mailing address:
  • Phone: 201-325-9009
  • Fax: 201-223-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA0715390
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: