Provider Demographics
NPI:1508816679
Name:GONZALEZ, PRISCILA N (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILA
Middle Name:N
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-9744
Mailing Address - Country:US
Mailing Address - Phone:732-460-5360
Mailing Address - Fax:732-460-7442
Practice Address - Street 1:2 CENTER PLZ
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-9744
Practice Address - Country:US
Practice Address - Phone:732-460-5360
Practice Address - Fax:732-460-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07243600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8968705Medicaid
NJ8968705Medicaid
NJH50440Medicare UPIN