Individual
WILSON GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 FERN DR, LAKE RONKONKOMA, NY 11779-4505
(631) 572-9585
Mailing address
2 FERN DR, LAKE RONKONKOMA, NY 11779-4505
(631) 572-9585
Taxonomy
Speciality
Code
Description
License number
State
344600000X
Taxi
Primary
5700567
NY
344600000X
Taxi
756867726
NY
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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