Basic Information
| Provider Information | |||||||||
| NPI: | 1407872211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | EFRAIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 SELWYN AVE FL 10 | ||||||||
| Address2: | BRONX-LEBANON HOSPITAL - DEPARTMENT OF MEDICINE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601234 | ||||||||
| FaxNumber: | 7189602033 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 SELWYN AVE FL 10 | ||||||||
| Address2: | BRONX-LEBANON HOSPITAL CENTER - DEPARTMENT OF MEDICINE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601234 | ||||||||
| FaxNumber: | 7189602055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 227212 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 227212 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 02674293 | 05 | NY | MEDICAID |