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General NPI Number Information
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NPI Number | 1972815397
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Entity Type | Organization
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Legal Business Name | JOSE A. GONZALEZ DC PC
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 1805 5TH AVE SUITE 2
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City | BAY SHORE
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State | NY
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Zip | 11706-1761
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Country | US
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Telephone | 631-219-1706
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Fax | 631-922-8878
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Provider Business Mailing Address
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Address Line | 7 MAYFIELD DR
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City | MASTIC BEACH
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State | NY
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Zip | 11951-1704
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Country | US
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Telephone | 631-219-1706
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Fax | 631-922-8878
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE A GONZALEZ
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Credential | DC
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Telephone | 631-219-1706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | XOO8699-1
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License Number State | NY
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