Provider Demographics
NPI:1831284348
Name:FELICIA GONZALEZ, DO, LLC
Entity Type:Organization
Organization Name:FELICIA GONZALEZ, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZLAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-240-0244
Mailing Address - Street 1:212 COMMONS WAY
Mailing Address - Street 2:BLDG. B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-240-0244
Mailing Address - Fax:732-240-0644
Practice Address - Street 1:212 COMMONS WAY
Practice Address - Street 2:BLDG. B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-240-0244
Practice Address - Fax:732-240-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06259300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty