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General NPI Number Information
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NPI Number | 1861380446
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Entity Type | Individual
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Provider Name | MARY JANE N GONZALES PHD, BCDNM, BCHHP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 390 5TH AVE RM 912
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City | NEW YORK
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State | NY
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Zip | 10018-8191
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Country | US
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Telephone | 856-313-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 16 ASTOR CT
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City | PRINCETON
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State | NJ
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Zip | 08540-7809
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Country | US
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Telephone |
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Fax |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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