Individual
MADELEINE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA
Contact information
Practice address
260 E 161ST ST, MELROSE TRACK, BRONX, NY 10451-3512
(718) 993-3397
Mailing address
1500 WATERS PL, EXECUTIVE OFFICE, BRONX, NY 10461-2723
(718) 409-9450
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004028
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00245643
—
NY
Enumeration date
03/22/2007
Last updated
06/26/2012
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