Ian Jerome Gonzales, R. EEG T, CLTM, CNIM

Primary specialty

EEG Specialist/TechnologistTaxonomy code 246ZE0500X

License

456 Issued in NJ

Practice address

161 Knickerbocker Rd Apt D
Englewood, NJ 07631-2156

Phone

(973) 752-9580

NPI assigned

Feb 8, 2023

Last updated

Feb 8, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1992402119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 KNICKERBOCKER RD",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312161",
            "telephone_number": "973-752-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 KNICKERBOCKER RD APT D",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312156",
            "telephone_number": "973-752-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "IAN",
        "middle_name": "JEROME",
        "credential": "R. EEG T, CLTM, CNIM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-08",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZE0500X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, EEG",
            "state": "NJ",
            "license": "456",
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": "NJ",
            "license": "4926",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard S Goldweit, MD, FACC
• Peter Goldzweig, DO
• Yakov Gologorsky, MD
• Jose Carlos Gomez-Marquez, M.D.
• Giancarlo Gomez, MD
• Good to 20 Neuromonitoring, LLC
• Gizela Gali Goodman, LCSW, MSED
• Carolyn E Goodstein, MD
• Jennifer Goonetilleke
• Mahalakshmi Gopalakrishnamoorthy, MD

• Other Specialist/Technologist in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Other Specialist/Technologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.