=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689925612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD H GONZALEZ MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2012
-----------------------------------------------------
Last Update Date | 10/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 666 PLAINSBORO RD STE 1318
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-785-5067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 63
-----------------------------------------------------
City | SKILLMAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08558-0063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-785-5067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RONALD H GONZALEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-785-5067
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------