Provider Demographics
NPI:1215351820
Name:GONCALVES, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GONCALVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1418
Mailing Address - Country:US
Mailing Address - Phone:908-233-2200
Mailing Address - Fax:908-233-3975
Practice Address - Street 1:1115 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1418
Practice Address - Country:US
Practice Address - Phone:908-233-2200
Practice Address - Fax:908-233-3975
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI031909001835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear