Provider Demographics
NPI:1952341232
Name:GONZALES, MARJORIE M (PC)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:M
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1650 ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1708
Mailing Address - Country:US
Mailing Address - Phone:609-588-0158
Mailing Address - Fax:609-588-5791
Practice Address - Street 1:3469 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1203
Practice Address - Country:US
Practice Address - Phone:609-588-0158
Practice Address - Fax:609-588-5791
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA062781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19658Medicare UPIN
NJ813183U26Medicare PIN