Provider Demographics
NPI:1568667160
Name:GONZALEZ, CHRISTIAN P (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:P
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 WALDO AVE
Mailing Address - Street 2:APT. # 6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2247
Mailing Address - Country:US
Mailing Address - Phone:646-327-7842
Mailing Address - Fax:
Practice Address - Street 1:3636 WALDO AVE
Practice Address - Street 2:APT. # 6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2247
Practice Address - Country:US
Practice Address - Phone:646-327-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine