Individual
MARIANO GONZALEZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
380 OLD TOWN RD, EAST SETAUKET, NY 11733-3482
(631) 730-4980
Mailing address
100 SUFFOLK AVE, STONY BROOK, NY 11790-1821
(631) 730-4000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002969
NY
Other
Enumeration date
01/31/2025
Last updated
01/31/2025
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