Healthcare Provider Details

I. General information

NPI: 1609260702
Provider Name (Legal Business Name): GOMEZ NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WOLF RD
ALBANY NY
12205-1244
US

IV. Provider business mailing address

1252 KEYES AVE
SCHENECTADY NY
12309-5728
US

V. Phone/Fax

Practice location:
  • Phone: 518-650-2090
  • Fax: 855-420-6025
Mailing address:
  • Phone: 518-285-0782
  • Fax: 855-420-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number473187
License Number StateNY

VIII. Authorized Official

Name: DR. FRANCISCO JAVIER GOMEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 518-285-0782