Individual
EVELYN GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3 COOPER PLZ, SUITE200, CAMDEN, NJ 08103-1438
(856) 342-2001
(856) 963-2499
Mailing address
1 FEDERAL ST STE 200, CAMDEN, NJ 08103-1088
(856) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
07070
PR
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
07070
PR
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
25MA08873300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2230-5
PROSSAM PROVIDER
PR
01
—
80190 GO
TRIPLE-S PROVIDER NUMBER
PR
01
—
9260212
HUMANA INSURANCE PROVIDER
PR
01
—
SE 2613
PALIC PROVIDER NUMBER
PR
Enumeration date
06/30/2006
Last updated
03/22/2021
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