Provider Demographics
NPI:1447793773
Name:GONZALEZ, SARAH JOY (PNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 RIVINGTON ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2581
Mailing Address - Country:US
Mailing Address - Phone:310-318-4238
Mailing Address - Fax:
Practice Address - Street 1:4781 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4915
Practice Address - Country:US
Practice Address - Phone:866-643-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382677363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics