Provider Demographics
NPI:1306812037
Name:GOZO, AVE O (MD)
Entity type:Individual
Prefix:
First Name:AVE
Middle Name:O
Last Name:GOZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2840 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4851
Mailing Address - Country:US
Mailing Address - Phone:908-588-9860
Mailing Address - Fax:908-686-8791
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04252400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA60578Medicare UPIN