MEDICARE: PAUL EDWARD GONZALEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	270724	NY

General Provider Information

NPI Number	:	1194151712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL EDWARD GONZALEZ MD

Provider Business Mailing Address
First Line	:	3540 82ND ST STE 1D
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5106
Country	:	US
Telephone Number	:	718-507-5800
Fax Number	:	718-507-2154

Provider Business Practice Location Address
First Line	:	3540 82ND ST STE 1D
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5106
Country	:	US
Telephone Number	:	718-507-5800
Fax Number	:	718-507-2154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	10/01/2024

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