Healthcare Provider Details

I. General information

NPI: 1649809963
Provider Name (Legal Business Name): ADAM GOMEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

64 RANGER RD
DUMONT NJ
07628-1833
US

V. Phone/Fax

Practice location:
  • Phone: 646-877-4910
  • Fax:
Mailing address:
  • Phone: 201-233-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number661547
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: