Active NPI
Gem Paula Dagondon Gonzaga, PT
- Physical Therapist
- Patchogue, NY
National Provider Identifier
1417566118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 040496-1
- Practice address
- 25 Schoenfeld Blvd
Patchogue, NY 11772-2982 - Phone
- (631) 289-7700
- NPI assigned
- Jul 28, 2020
- Reactivated
- Jan 13, 2021
- 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 | 040496-1 | NY | Primary |
Addresses
Primary practice location
25 Schoenfeld Blvd
Patchogue, NY 11772-2982
Mailing address
17 Linden LN
Farmingville, NY 11738-1134
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040496-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610496000000",
"number": "1417566118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 LINDEN LN",
"city": "FARMINGVILLE",
"state": "NY",
"postal_code": "117381134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 SCHOENFELD BLVD",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722982",
"telephone_number": "631-289-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZAGA",
"first_name": "GEM PAULA",
"middle_name": "DAGONDON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-28",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"deactivation_date": "2020-09-09",
"reactivation_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "040496-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.