Healthcare Provider Details

I. General information

NPI: 1881852366
Provider Name (Legal Business Name): JOHN ALEXANDER GONZALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 ROCHAMBEAU AVE THIRD FLOOR
BRONX NY
10467-2836
US

IV. Provider business mailing address

3332 ROCHAMBEAU AVE THIRD FLOOR
BRONX NY
10467-2836
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2020
  • Fax:
Mailing address:
  • Phone: 718-920-2020
  • Fax: 718-881-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA117305
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number266959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: