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NPI Code Detail

MEDICARE: CARLOS M GONZALEZ PA

MEDICARE: CARLOS M GONZALEZ PA
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
1363A00000XPhysician Assistant005942NY

General Provider Information

NPI Number : 1497752711
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS M GONZALEZ PA
Provider Business Mailing Address
First Line : 1065 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-2417
Country : US
Telephone Number : 718-589-2440
Fax Number :
Provider Business Practice Location Address
First Line : 1065 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-2417
Country : US
Telephone Number : 718-589-2440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 06/12/2013

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Directions to “ CARLOS M GONZALEZ PA” Practice Location

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