Mariano Gonzalez Jr., ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

002969 Issued in NY

Practice address

380 Old Town Rd
East Setauket, NY 11733-3482

Phone

(631) 730-4980

NPI assigned

Jan 31, 2025

Last updated

Jan 31, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1738281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1427861517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SUFFOLK AVE",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901821",
            "telephone_number": "631-730-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 OLD TOWN RD",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333482",
            "telephone_number": "631-730-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MARIANO",
        "name_suffix": "Jr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-31",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Goldberg, C.P.O
• Amy Melissa Goldstein, OTR/L
• Gwen L Goldstein, M.S.
• Nancy R Goldstein, LCSW-R
• Jennifer Gonzalez, M.D.
• David Goodrich, M.D.
• Chirayu V Gor, M.D.
• Gordon J Diehl DMD PC
• Farzan Gorgani, D.O.
• Katie Leigh Grady, NP

• Athletic Trainer in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.