Provider Demographics
NPI:1487774469
Name:GONZALEZ, ROSA (PA)
Entity type:Individual
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First Name:ROSA
Middle Name:
Last Name:GONZALEZ
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Gender:F
Credentials:PA
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Mailing Address - Street 1:114- 06 QUEENS BOULEVARD
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-275-5512
Mailing Address - Fax:718-275-5509
Practice Address - Street 1:114- 06 QUEENS BLVD
Practice Address - Street 2:SUITE 1G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-275-5512
Practice Address - Fax:718-275-5509
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2010-07-07
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Provider Licenses
StateLicense IDTaxonomies
NY003752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical