Provider Demographics
NPI:1265514079
Name:GONZALEZ, PEDRO PIOLAN (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:PIOLAN
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 1:25 PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735
Mailing Address - Country:US
Mailing Address - Phone:732-830-3700
Mailing Address - Fax:732-830-7793
Practice Address - Street 1:25 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735
Practice Address - Country:US
Practice Address - Phone:732-830-3700
Practice Address - Fax:732-830-7793
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54291Medicare UPIN