Healthcare Provider Details

I. General information

NPI: 1114772704
Provider Name (Legal Business Name): CHRISTOPHER GONZALEZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 168TH ST
NEW YORK NY
10032-3726
US

IV. Provider business mailing address

710 W 168TH ST
NEW YORK NY
10032-3726
US

V. Phone/Fax

Practice location:
  • Phone: 877-426-5637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: