Provider Demographics
NPI:1396286597
Name:GONZALEZ, MELISSA MAXINE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAXINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 ROUTE 66 BLDG B
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2705
Mailing Address - Country:US
Mailing Address - Phone:848-217-2700
Mailing Address - Fax:732-922-1580
Practice Address - Street 1:3301 ROUTE 66 STE 102
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2705
Practice Address - Country:US
Practice Address - Phone:848-217-2700
Practice Address - Fax:732-922-1580
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10711400207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty