Provider Demographics
NPI:1447322128
Name:GONZALES, SYLVIA A (MD)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4732
Mailing Address - Country:US
Mailing Address - Phone:718-221-4213
Mailing Address - Fax:
Practice Address - Street 1:1599 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4732
Practice Address - Country:US
Practice Address - Phone:718-221-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01532961Medicaid
NYF92719Medicare UPIN
NY62J811Medicare ID - Type Unspecified