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General NPI Number Information
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NPI Number | 1134810757
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Entity Type | Individual
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Provider Name | MEGAN GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 74 COMMERCE AVE STE 3
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City | RIVERHEAD
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State | NY
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Zip | 11901-3105
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Country | US
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Telephone | 631-369-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | NY
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