Provider Demographics
NPI:1861740037
Name:GONZALEZ, MARY-SUTTON
Entity type:Individual
Prefix:MS
First Name:MARY-SUTTON
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMERCE ST
Mailing Address - Street 2:APARTMENT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3752
Mailing Address - Country:US
Mailing Address - Phone:813-447-9074
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE ST
Practice Address - Street 2:APARTMENT 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3752
Practice Address - Country:US
Practice Address - Phone:813-447-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist