Provider Demographics
NPI:1285438788
Name:GONZALEZ, ANDREW P (LAC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WESTFIELD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2428
Mailing Address - Country:US
Mailing Address - Phone:201-407-5614
Mailing Address - Fax:
Practice Address - Street 1:132 WESTFIELD AVE STE 3
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2428
Practice Address - Country:US
Practice Address - Phone:732-763-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program