Provider Demographics
NPI:1376146332
Name:ROBERTO GONZALES JAVIER, NURSE PRACTITIONER IN ADULT HEALTH, P.L.L.C.
Entity Type:Organization
Organization Name:ROBERTO GONZALES JAVIER, NURSE PRACTITIONER IN ADULT HEALTH, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-420-7869
Mailing Address - Street 1:4520 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3331
Mailing Address - Country:US
Mailing Address - Phone:212-671-0978
Mailing Address - Fax:
Practice Address - Street 1:8635 QUEENS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4408
Practice Address - Country:US
Practice Address - Phone:347-420-7869
Practice Address - Fax:718-565-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care