MEDICARE: PAULA A GONZALEZ

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	225200000X	Physical Therapy Assistant	40QB00282300	NJ

General Provider Information

NPI Number	:	1740798156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA A GONZALEZ

Provider Business Mailing Address
First Line	:	11 EAGLE ROCK AVE
Second Line	:
City	:	EAST HANOVER
State	:	NJ
Zip	:	07936-3167
Country	:	US
Telephone Number	:	973-887-9000
Fax Number	:	973-887-3816

Provider Business Practice Location Address
First Line	:	6612 BERGENLINE AVE # 18
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1719
Country	:	US
Telephone Number	:	201-854-5511
Fax Number	:	201-854-5522

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

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/19/2018

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Directions to “ PAULA A GONZALEZ ” Practice Location

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