Healthcare Provider Details

I. General information

NPI: 1114355302
Provider Name (Legal Business Name): LILIET GOMEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 03/07/2023
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 33RD ST FL 5
NEW YORK NY
10016-5337
US

IV. Provider business mailing address

14 OAK ST APT 1
BRUNSWICK ME
04011-1980
US

V. Phone/Fax

Practice location:
  • Phone: 123-554-4592
  • Fax: 347-823-1561
Mailing address:
  • Phone: 978-407-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339633-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: