Healthcare Provider Details

I. General information

NPI: 1972187003
Provider Name (Legal Business Name): MRS. ANNA H. GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 BRIGHTON 3RD ST
BROOKLYN NY
11235-6762
US

IV. Provider business mailing address

2865 BRIGHTON 3RD ST
BROOKLYN NY
11235-6762
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-4400
  • Fax: 718-484-1235
Mailing address:
  • Phone: 718-891-4400
  • Fax: 718-484-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number429848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: