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General NPI Number Information
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NPI Number | 1841552627
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Entity Type | Individual
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Provider Name | MS. EDITH JANNETTE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 13420 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11418-2619
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Country | US
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Telephone | 718-206-8440
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Fax | 718-206-8441
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Provider Business Mailing Address
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Address Line | 134-20 JAMAICA AVE.
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City | JAMAICA
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State | NY
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Zip | 11418
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Country | US
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Telephone | 718-206-8440
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Fax | 718-206-8441
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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