Provider Demographics
NPI:1538357504
Name:DR. MARJORIE M. GONZALES, PC
Entity type:Organization
Organization Name:DR. MARJORIE M. GONZALES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-588-0158
Mailing Address - Street 1:3469 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1203
Mailing Address - Country:US
Mailing Address - Phone:609-588-0158
Mailing Address - Fax:609-588-5791
Practice Address - Street 1:3469 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1203
Practice Address - Country:US
Practice Address - Phone:609-588-0158
Practice Address - Fax:609-588-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098643Medicare PIN