Provider Demographics
NPI:1700817475
Name:GONZALEZ, ANGELA E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:E
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 1:600 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2604
Mailing Address - Country:US
Mailing Address - Phone:718-920-9648
Mailing Address - Fax:
Practice Address - Street 1:4170 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2656
Practice Address - Country:US
Practice Address - Phone:718-920-9600
Practice Address - Fax:718-920-6840
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205944207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859416Medicaid
G74146Medicare UPIN
NY01859416Medicaid