Provider Demographics
NPI:1306097951
Name:GONZALES, MICHAEL (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:249 BRIDGE ST
Mailing Address - Street 2:BUILDING G
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2294
Mailing Address - Country:US
Mailing Address - Phone:732-516-1060
Mailing Address - Fax:732-516-0090
Practice Address - Street 1:102 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4688
Practice Address - Country:US
Practice Address - Phone:908-359-3499
Practice Address - Fax:908-359-2788
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00053700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist