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NPI Code Detail

MEDICARE: MS. MARISSA A MIKULSKI-GOMEZ MSED

MEDICARE: MS. MARISSA A MIKULSKI-GOMEZ MSED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1538421383
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARISSA A MIKULSKI-GOMEZ MSED
Provider Business Mailing Address
First Line : 81 BOULDER RUN RD
Second Line :
City : PATERSON
State : NJ
Zip : 07501-3354
Country : US
Telephone Number : 646-541-4456
Fax Number :
Provider Business Practice Location Address
First Line : 1133 WESTCHESTER AVE STE N-230
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10604-3522
Country : US
Telephone Number : 914-576-5292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2012
Last Update Date : 03/30/2022

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Directions to “ MS. MARISSA A MIKULSKI-GOMEZ MSED” Practice Location

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