Healthcare Provider Details

I. General information

NPI: 1982485710
Provider Name (Legal Business Name): MILCI GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILCI ABREU

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAIN ST STE 205
SPRING VALLEY NY
10977-3776
US

IV. Provider business mailing address

PO BOX 2
KEARNY NJ
07032-0002
US

V. Phone/Fax

Practice location:
  • Phone: 845-356-1430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421672
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number707310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: