Gonzalez, Mario Segundo
Gonzalez, Mario Segundo is an individual health care provider with primary practice located at 111 Central Ave , Newark NJ 07102. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Gonzalez, Mario Segundo can be contacted via phone (973) 877-5200.Contact Information
Primary practice address
111 Central Ave
Newark NJ 07102
Phone: (973) 877-5200
Fax: (973) 877-2468
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 25MA07983800 | New Jersey |
Profile Details
| NPI number | 1952414476 |
|---|---|
| LBN Legal business name | Gonzalez, Mario Segundo |
| Credentials | MD FCAP FASCP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 17th, 2006 |
| Last updated | Apr 30th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952414476 | NPPES |
| Rhode Island | MEDICAID | MG87904 | |
| Rhode Island | MEDICAID | 095128 | |
| Rhode Island | MEDICAID | 0081451 |
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