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General NPI Number Information
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NPI Number | 1396286597
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Entity Type | Individual
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Provider Name | MELISSA MAXINE GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 3301 ROUTE 66 STE 102
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City | NEPTUNE
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State | NJ
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Zip | 07753-2705
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Country | US
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Telephone | 848-217-2700
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Fax | 732-922-1580
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Provider Business Mailing Address
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Address Line | 3301 ROUTE 66 BLDG B
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City | NEPTUNE
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State | NJ
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Zip | 07753-2705
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Country | US
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Telephone | 848-217-2700
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Fax | 732-922-1580
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA10711400
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License Number State | NJ
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