=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851357792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LETICIA RAMOS GONZALEZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 SHUNPIKE RD
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07940-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-377-2073
-----------------------------------------------------
Fax | 973-377-2181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 BARBERRY RD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-267-8579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MA26587
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------