Basic Information
| Provider Information | |||||||||
| NPI: | 1962816843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ GONZALEZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | ALONSO | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 YORK AVE FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620602 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 YORK AVE FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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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 | 259810 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207W00000X | MT208832 | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | RS2017-0161 | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207WX0107X | 293071 | NY | Y |
No ID Information.