Provider Demographics
NPI:1689610701
Name:GONZALES, LORENZO AZCARATE (PT)
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:AZCARATE
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 REILLY CT
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2917
Mailing Address - Country:US
Mailing Address - Phone:732-549-3534
Mailing Address - Fax:
Practice Address - Street 1:760 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-661-1121
Practice Address - Fax:732-661-1151
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01056700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist