Individual
MIGUEL GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
718 TEANECK RD, TEANECK, NJ 07666-4245
(201) 833-3000
Mailing address
3 UNIVERSITY PLZ STE 205, HACKENSACK, NJ 07601-6208
(201) 833-3000
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
26NJ00962200
NJ
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00962200
NJ
363LG0600X
Gerontology Nurse Practitioner
26NJ00962200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0702714
—
NJ
01
—
1790396281
TITAN HEALTH GROUP NPI#
NJ
Enumeration date
08/20/2019
Last updated
08/25/2021
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