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NPI Code Detail

MEDICARE: OSVALDO MOREIRA-GONZALEZ PA-C

MEDICARE: OSVALDO MOREIRA-GONZALEZ PA-C
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
1363AS0400XSurgical Physician Assistant
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1801598479
Entity Type Code : Individual
Provider Name (Legal Business Name) : OSVALDO MOREIRA-GONZALEZ PA-C
Provider Business Mailing Address
First Line : 209 HAWKINS AVE
Second Line :
City : RONKONKOMA
State : NY
Zip : 11779-4265
Country : US
Telephone Number : 631-897-4567
Fax Number : 631-350-0519
Provider Business Practice Location Address
First Line : 105 MEDFORD AVE
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-1223
Country : US
Telephone Number : 631-580-1000
Fax Number : 631-350-0519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 12/09/2025

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Directions to “ OSVALDO MOREIRA-GONZALEZ PA-C” Practice Location

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