Individual
MARIO SEGUNDO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FCAP FASCP
Contact information
Practice address
111 CENTRAL AVE, NEWARK, NJ 07102
(973) 877-5200
(973) 877-2468
Mailing address
20 NASSAU ST, SUITE 216, PRINCETON, NJ 08542-4509
(609) 924-3588
(609) 924-3581
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA07983800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081451
—
NJ
05
—
095128
—
NJ
05
—
MG87904
—
RI
Enumeration date
08/17/2006
Last updated
04/30/2012
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