Provider Demographics
NPI:1962685933
Name:PATRIA GONZALEZ, MD, PC
Entity Type:Organization
Organization Name:PATRIA GONZALEZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-544-9112
Mailing Address - Street 1:232 SHERMAN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2503
Mailing Address - Country:US
Mailing Address - Phone:212-544-9112
Mailing Address - Fax:212-544-9113
Practice Address - Street 1:232 SHERMAN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2503
Practice Address - Country:US
Practice Address - Phone:212-544-9112
Practice Address - Fax:212-544-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02058780Medicaid
NYBG6532813OtherDEA
NY=========OtherTAX ID#
NY=========OtherTAX ID#
NY02058780Medicaid