Provider Demographics
NPI:1922592112
Name:GONZALEZ, JILLIAN C (MS)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 AUBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1629
Mailing Address - Country:US
Mailing Address - Phone:631-578-3160
Mailing Address - Fax:
Practice Address - Street 1:344 AUBORN AVE
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1629
Practice Address - Country:US
Practice Address - Phone:631-578-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator