Healthcare Provider Details

I. General information

NPI: 1306072772
Provider Name (Legal Business Name): EMELITA GOMEZ LAO REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMELITA GOMEZ LAO REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SYCAMORE RD
JERSEY CITY NJ
07305-1239
US

IV. Provider business mailing address

51 SYCAMORE RD
JERSEY CITY NJ
07305-1239
US

V. Phone/Fax

Practice location:
  • Phone: 201-451-0269
  • Fax:
Mailing address:
  • Phone: 201-451-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO09926400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number26NO09926400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number26NO09926400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: