Provider Demographics
NPI:1740749886
Name:GONZALEZ, CHRISTINE R
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 WATEREDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3728
Mailing Address - Country:US
Mailing Address - Phone:516-532-4173
Mailing Address - Fax:
Practice Address - Street 1:519 WATEREDGE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3728
Practice Address - Country:US
Practice Address - Phone:516-532-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist