Individual
JONATHAN ORIO GONZAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
14-25 PLAZA RD, S31, FAIR LAWN, NJ 07410-3546
(201) 797-2050
(201) 797-2051
Mailing address
14-25 PLAZA RD, S-3-1, FAIR LAWN, NJ 07410-3546
(201) 797-2050
(201) 797-2051
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
028580
NY
174400000X
Specialist
Primary
40QA01303200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028580
LICENSE
NY
01
—
40QA01303200
LICENSE
NJ
Enumeration date
03/06/2008
Last updated
06/06/2013
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