Individual
DR. FAUSTO A GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13405 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-3020
(718) 323-5500
Mailing address
13405 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-3020
(718) 323-9700
(718) 323-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
229968-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0258138
—
NY
01
—
2590034
GHI PPO
NY
01
—
286588
WELLCARE
NY
Enumeration date
03/21/2006
Last updated
05/17/2023
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