Provider Demographics
NPI:1831445543
Name:GONZALES, MAYU (MD)
Entity type:Individual
Prefix:DR
First Name:MAYU
Middle Name:
Last Name:GONZALES
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 1:500 E 83RD ST
Mailing Address - Street 2:2J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7243
Mailing Address - Country:US
Mailing Address - Phone:212-734-1442
Mailing Address - Fax:
Practice Address - Street 1:500 E 83RD ST
Practice Address - Street 2:2J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7243
Practice Address - Country:US
Practice Address - Phone:212-734-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1270692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry