Individual provider Active NPI

Ernesto Eleazar Gonzalez, M.D.

  • Psychiatry Physician
  • Brooklyn, NY
National Provider Identifier
1174765556
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2084P0800X Issued in MA
Practice address
760 Broadway
Brooklyn, NY 11206-5317
Phone
(203) 676-2422
NPI assigned
Mar 31, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2084P0800X MA Primary

Addresses

Primary practice location

760 Broadway
Brooklyn, NY 11206-5317

Mailing address

203 Arleigh Rd
Douglaston, NY 11363-1142
Phone (203) 676-2422

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address egonzalez152954@nyumc.direct-ci.com NYU Langone Hospitals

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT, NJ3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140620000075 NY Practitioner - Psychiatry 1456595966 Reassigns benefits to 2 organizations
I20231102001713 CT Practitioner - Psychiatry 1456595966 Reassigns benefits to 1 organization
I20231107001192 NJ Practitioner - Psychiatry 1456595966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD Psychiatry Services PLLCGroup PAC ID 4082049036, 206 clinicians

Practice addresses (Care Compare)

109 W 27TH St
5S
New York, NY 10001-6208
Phone (833) 351-8255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2084P0800XMAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Sep 23, 2023 Accepting new patients
MCCD New Jersey Psychiatry Services LLC Psychiatry CurrentSince Sep 23, 2023 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Dec 1, 2016 Accepting new patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince Oct 1, 2023 Accepting new patients
St John's Medical Services PC CurrentSince May 29, 2023 Accepting new patients
NYU Langone Hospitals CurrentSince Dec 1, 2016 Accepting new patients

Locations

777 W Putnam Ave
Ste 300
Greenwich, CT 06830
Phone (203) 542-2808

525 Route 73 N
Ste 117
Marlton, NJ 08053
Phone (609) 200-0444

514 49th St
Brooklyn, NY 11220
Phone (718) 431-2600

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

327 Beach 19th St
Far Rockaway, NY 11691
Phone (718) 689-7640

109 W 27th St
#55
New York, NY 10001

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14448/brand/1/csg/1/fhir/r4
  • Direct secure messaging: egonzalez1454370@nychhc.direct-ci.com
  • Direct secure messaging: egonzalez152954@nyumc.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1174765556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 ARLEIGH RD",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113631142",
            "telephone_number": "203-676-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112065317",
            "telephone_number": "203-676-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "ERNESTO",
        "middle_name": "ELEAZAR",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-31",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "2084P0800X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egonzalez152954@nyumc.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "NYU Langone Hospitals",
            "address_1": "150 55th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112202559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.