Healthcare Provider Details

I. General information

NPI: 1841388162
Provider Name (Legal Business Name): LUPE AMY GONZALEZ R.P.T. L.AC. R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 BLOOMFIELD AVE STE 201
WEST CALDWELL NJ
07006
US

IV. Provider business mailing address

1099 BLOOMFIELD AVE STE 201
WEST CALDWELL NJ
07006-7129
US

V. Phone/Fax

Practice location:
  • Phone: 973-227-7277
  • Fax:
Mailing address:
  • Phone: 973-227-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR06203400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00409000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00024400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: