Provider Demographics
NPI:1518987783
Name:GONZALEZ, JOSE A JR (DC DPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:DC DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 WADING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-1107
Mailing Address - Country:US
Mailing Address - Phone:613-574-0239
Mailing Address - Fax:
Practice Address - Street 1:164 WADING RIVER RD
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-1107
Practice Address - Country:US
Practice Address - Phone:613-574-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008699111N00000X
NY037176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor