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General NPI Number Information
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NPI Number | 1245730027
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Entity Type | Individual
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Provider Name | VIRGILIO GONZAGA JR. RN
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Gender | Male
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Dates
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Enumeration Date | 02/18/2018
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 1401 PELHAM PKWY N
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City | BRONX
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State | NY
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Zip | 10469-5809
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Country | US
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Telephone | 917-331-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 174 BAIER AVE APT 106
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City | SOMERSET
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State | NJ
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Zip | 08873-2043
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 725963
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License Number State | NY
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