Provider Demographics
NPI:1386823367
Name:ANTERO B. GONZALES M.D.
Entity Type:Organization
Organization Name:ANTERO B. GONZALES M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTERO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-920-4666
Mailing Address - Street 1:35 BEAVERSON BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7812
Mailing Address - Country:US
Mailing Address - Phone:732-920-4666
Mailing Address - Fax:732-920-5387
Practice Address - Street 1:35 BEAVERSON BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7812
Practice Address - Country:US
Practice Address - Phone:732-920-4666
Practice Address - Fax:732-920-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029654OtherMEDICARE UPIN GROUP #