Provider Demographics
NPI:1962816843
Name:GONZALEZ GONZALEZ, LUIS ALONSO (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALONSO
Last Name:GONZALEZ GONZALEZ
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:908-967-5488
Practice Address - Street 1:628 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1704
Practice Address - Country:US
Practice Address - Phone:201-837-7300
Practice Address - Fax:201-836-6426
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10786500207W00000X
PAMT208832207W00000X
NMRS2017-0161390200000X
NY293071207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program