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General NPI Number Information
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NPI Number | 1114691268
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Entity Type | Organization
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Legal Business Name | ANDREAS GOMOLL ORTHOPAEDIC, PLLC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 523 E 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10021-4099
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Country | US
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Telephone | 212-606-1775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12204
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City | HAUPPAUGE
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State | NY
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Zip | 11788-0614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | ANDREAS HANS GOMOLL
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Credential | MD
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Telephone | 617-610-4858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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