Provider Demographics
NPI:1437162054
Name:GONZALEZ, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
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 1:4107 76TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1929
Mailing Address - Country:US
Mailing Address - Phone:718-803-3201
Mailing Address - Fax:718-803-0085
Practice Address - Street 1:4107 76TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1929
Practice Address - Country:US
Practice Address - Phone:718-803-3201
Practice Address - Fax:718-803-0085
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156591173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0402872OtherUNITED HEALTHCARE
NY15659101OtherNEIGHBORHOOD
NY113394561Other1199
NY4C3877OtherHEALTHNET
NYP00156591OtherOXFORD
NY040426018611OtherFIDELIS
NY21D17OtherEMPIRE BC/BS
NYQN0029702OtherAMERICHOICE
NY113394561OtherAETNA
NY287760101OtherHEALTHPLUS
NYAS74100570001OtherCIGNA
NY00156591OtherMETROPLUS
NY113394561OtherGHI
NY156591A29OtherHEALTHFIRST
NY00834244Medicaid
NY149808OtherWELLCARE
NYOH345POtherHIP
NY00834244Medicaid
NY15659101OtherNEIGHBORHOOD