Healthcare Provider Details

I. General information

NPI: 1497825129
Provider Name (Legal Business Name): MERY CONCEPCION GOMEZ M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

IV. Provider business mailing address

1371 SEABURY AVE
BRONX NY
10461-3651
US

V. Phone/Fax

Practice location:
  • Phone: 646-722-7610
  • Fax:
Mailing address:
  • Phone: 718-583-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number218769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: