Provider Demographics
NPI:1568556520
Name:GONZALEZ, JUAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
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 1:3196 KENNEDY BLVD
Mailing Address - Street 2:MAILBOX16A
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2436
Mailing Address - Country:US
Mailing Address - Phone:201-795-9080
Mailing Address - Fax:201-795-9434
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-795-9080
Practice Address - Fax:201-795-9434
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04258800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2468687OtherAETNA
NJ3444104Medicaid
P2368176OtherOXFORD
0844102OtherCIGNA
1413HOtherEMPIRE BC
NJ155409Medicare ID - Type Unspecified
2468687OtherAETNA