Provider Demographics
NPI:1679654099
Name:GONZALEZ-MELQUIADES, JOAQUIN EMILIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:EMILIO
Last Name:GONZALEZ-MELQUIADES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MC CONACHY LANE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825
Mailing Address - Country:US
Mailing Address - Phone:908-922-9200
Mailing Address - Fax:
Practice Address - Street 1:3 MCCONACHY LANE
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825
Practice Address - Country:US
Practice Address - Phone:908-922-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant