Provider Demographics
NPI:1073808887
Name:ORLANDO GONZALEZ, JR., M.D., P.C.
Entity Type:Organization
Organization Name:ORLANDO GONZALEZ, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-6034
Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4513
Mailing Address - Country:US
Mailing Address - Phone:718-273-6034
Mailing Address - Fax:718-815-0941
Practice Address - Street 1:78 TODT HILL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4513
Practice Address - Country:US
Practice Address - Phone:718-273-6034
Practice Address - Fax:718-815-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1580351207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61613Medicare UPIN
25E831Medicare PIN