Provider Demographics
NPI:1194151712
Name:GONZALEZ, PAUL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 82ND ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5106
Mailing Address - Country:US
Mailing Address - Phone:718-507-5800
Mailing Address - Fax:718-507-2154
Practice Address - Street 1:3540 82ND ST STE 1D
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5106
Practice Address - Country:US
Practice Address - Phone:718-507-5800
Practice Address - Fax:718-507-2154
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY270724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics