1720224975 NPI number — MR. MICHAEL GONZALEZ RPH.

Table of content: MR. MICHAEL GONZALEZ RPH. (NPI 1720224975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720224975 NPI number — MR. MICHAEL GONZALEZ RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720224975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6012 KENNEDY BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST NEW YORK, NJ 07093, USA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-869-9004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12207-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-445-7657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH024063 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 28RI02921000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com