Healthcare Provider Details

I. General information

NPI: 1619179066
Provider Name (Legal Business Name): SHEILA S GONZALEZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BETH ISRAEL MEDICAL CENTER FIRST AVE AT 16TH ST
NEW YORK NY
10003
US

IV. Provider business mailing address

2535 47TH ST APT 2F
ASTORIA NY
11103-1108
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010345-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: