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General NPI Number Information
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NPI Number | 1801598479
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Entity Type | Individual
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Provider Name | OSVALDO MOREIRA-GONZALEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 105 MEDFORD AVE
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City | PATCHOGUE
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State | NY
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Zip | 11772-1223
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Country | US
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Telephone | 631-580-1000
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Fax | 631-350-0519
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Provider Business Mailing Address
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Address Line | 209 HAWKINS AVE
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City | RONKONKOMA
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State | NY
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Zip | 11779-4265
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Country | US
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Telephone | 631-897-4567
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Fax | 631-350-0519
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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