Provider Demographics
NPI:1770828519
Name:GONZALEZ, UBALDO (MD)
Entity Type:Individual
Prefix:MR
First Name:UBALDO
Middle Name:
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:PO BOX 248
Mailing Address - Street 2:885 ORCHARD ST.
Mailing Address - City:NEW SUFFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:11956-0248
Mailing Address - Country:US
Mailing Address - Phone:631-734-5972
Mailing Address - Fax:
Practice Address - Street 1:885 ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:NEW SUFFOLK
Practice Address - State:NY
Practice Address - Zip Code:11956-0248
Practice Address - Country:US
Practice Address - Phone:631-734-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery