Provider Demographics
NPI:1376691881
Name:GONZALEZ, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE ANTONIO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5655
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-0655
Mailing Address - Country:US
Mailing Address - Phone:518-466-1129
Mailing Address - Fax:
Practice Address - Street 1:1425 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2702
Practice Address - Country:US
Practice Address - Phone:518-496-0862
Practice Address - Fax:518-435-9431
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1617542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51038BMedicare ID - Type Unspecified
NYC59451Medicare UPIN