Provider Demographics
NPI:1306916531
Name:GONZALEZ PANTALEON, ADALBERTO DE JESUS (MD)
Entity type:Individual
Prefix:
First Name:ADALBERTO
Middle Name:DE JESUS
Last Name:GONZALEZ PANTALEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 GROVE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:740 MARNE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-234-0645
Practice Address - Fax:856-234-0498
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD429605207R00000X
NJ25MA08785800207RE0101X
GA92880207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine