Individual
MS. VIRGINIA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 N MAIN ST, FREEPORT, NY 11520-2243
(516) 377-8014
Mailing address
976 NORTHERN BLVD, BALDWIN, NY 11510-4938
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03803761
—
NY
Enumeration date
06/20/2013
Last updated
03/17/2018
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