Provider Demographics
NPI:1841211265
Name:GONZALEZ, FREDERICK A (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
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 1:16 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4205
Mailing Address - Country:US
Mailing Address - Phone:914-523-4227
Mailing Address - Fax:914-231-9126
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:914-523-4227
Practice Address - Fax:914-231-9126
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6490754-1205207VM0101X
NY131268207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00843509Medicaid
UT00843509Medicaid
UT5265TYMedicare PIN