MEDICARE: JOSEFINA A. GOMEZ SP. ED.

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
1	174400000X	Specialist	13811332	NY

General Provider Information

NPI Number	:	1770846768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFINA A. GOMEZ SP. ED.

Provider Business Mailing Address
First Line	:	98 WIDMER RD
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3026
Country	:	US
Telephone Number	:	845-235-2441
Fax Number	:	845-632-1738

Provider Business Practice Location Address
First Line	:	98 WIDMER RD
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3026
Country	:	US
Telephone Number	:	845-235-2441
Fax Number	:	845-632-1738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	06/24/2012

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