Healthcare Provider Details

I. General information

NPI: 1295651834
Provider Name (Legal Business Name): DALILAH MARIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 NOSTRAND AVE
BROOKLYN NY
11235-2050
US

IV. Provider business mailing address

55 W 100TH ST APT 5E
NEW YORK NY
10025-4844
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax:
Mailing address:
  • Phone: 646-221-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: