Provider Demographics
NPI:1447804141
Name:GONZALES, MELINIE
Entity Type:Individual
Prefix:
First Name:MELINIE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:MILLSTONE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08510-1712
Practice Address - Country:US
Practice Address - Phone:732-439-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ1S12254303001OtherAMERIHEALTH