Healthcare Provider Details

I. General information

NPI: 1215351820
Provider Name (Legal Business Name): ALEX GONCALVES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 SOUTH AVE W
WESTFIELD NJ
07090-1418
US

IV. Provider business mailing address

1115 SOUTH AVE W
WESTFIELD NJ
07090-1418
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-2200
  • Fax: 908-233-3975
Mailing address:
  • Phone: 908-233-2200
  • Fax: 908-233-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number28RI03190900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: