Provider Demographics
NPI:1851357792
Name:GONZALEZ, LETICIA RAMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:RAMOS
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 1:4 BARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6906
Mailing Address - Country:US
Mailing Address - Phone:973-267-8579
Mailing Address - Fax:
Practice Address - Street 1:8 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2740
Practice Address - Country:US
Practice Address - Phone:973-377-2073
Practice Address - Fax:973-377-2181
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA26587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0291803Medicaid