Provider Demographics
NPI:1487972659
Name:GONZALEZ SIMON, JEANNETTE ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:ROSE
Last Name:GONZALEZ SIMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:19 HATHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2306
Mailing Address - Country:US
Mailing Address - Phone:917-294-4620
Mailing Address - Fax:
Practice Address - Street 1:19 HATHAWAY LN
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2306
Practice Address - Country:US
Practice Address - Phone:917-294-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB097861002080P0206X
NY2442982080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology