Active NPI
Jaclyn Anne Gonzalez
- Physical Therapist
- Midland Park, NJ
National Provider Identifier
1083222335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA00970800
- Practice address
- 85 Godwin Ave
Midland Park, NJ 07432-1970 - Phone
- (201) 639-8870
- Fax
- (201) 639-8874
- NPI assigned
- Jul 22, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA00970800 | NJ | Primary |
Addresses
Primary practice location
85 Godwin Ave
Midland Park, NJ 07432-1970
Mailing address
1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA00970800 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595376000000",
"number": "1083222335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1377 MOTOR PKWY STE 307",
"city": "ISLANDIA",
"state": "NY",
"postal_code": "117495258",
"telephone_number": "631-580-5200",
"fax_number": "631-760-8306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 GODWIN AVE",
"city": "MIDLAND PARK",
"state": "NJ",
"postal_code": "074321970",
"telephone_number": "201-639-8870",
"fax_number": "201-639-8874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "JACLYN",
"middle_name": "ANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-22",
"last_updated": "2020-07-22",
"certification_date": "2020-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA00970800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.