Active NPI
Wilson Gonzalez
- Taxi
- Lake Ronkonkoma, NY
National Provider Identifier
1740716745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Taxi
- License
- 5700567
- Practice address
- 2 Fern Dr
Lake Ronkonkoma, NY 11779-4505 - Phone
- (631) 572-9585
- NPI assigned
- May 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Taxi | 344600000X | 756867726 | NY | |
| Taxi | 344600000X | 5700567 | NY | Primary |
Addresses
Primary practice location
2 Fern Dr
Lake Ronkonkoma, NY 11779-4505
Mailing address
2 Fern Dr
Lake Ronkonkoma, NY 11779-4505
Phone (631) 572-9585
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 |
|---|---|---|---|
| 5700567 | NY | MD | Taxi |
| 756867726 | NY | MD | Taxi |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1740716745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 FERN DR",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117794505",
"telephone_number": "631-572-9585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 FERN DR",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117794505",
"telephone_number": "631-572-9585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "WILSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "344600000X",
"taxonomy_group": "",
"desc": "Taxi",
"state": "NY",
"license": "756867726",
"primary": false
},
{
"code": "344600000X",
"taxonomy_group": "",
"desc": "Taxi",
"state": "NY",
"license": "5700567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.