Provider Demographics
NPI:1861682270
Name:GONZALEZ-MORALES, PEDRO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
Last Name:GONZALEZ-MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:317 EAST 18TH STREET
Mailing Address - Street 2:APT 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2776
Mailing Address - Country:US
Mailing Address - Phone:318-212-8780
Mailing Address - Fax:318-212-6752
Practice Address - Street 1:145 E 32ND ST
Practice Address - Street 2:STE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6055
Practice Address - Country:US
Practice Address - Phone:718-320-4466
Practice Address - Fax:718-991-3829
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA201608207R00000X, 207RI0200X
LAMD.201608207RI0200X
NY240275207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1005673Medicaid
NY00695941Medicaid
LA1005673Medicaid
NYW6L111Medicare Oscar/Certification
NY00695941Medicaid
NY331952Medicare Oscar/Certification