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General NPI Number Information
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NPI Number | 1396549325
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Entity Type | Individual
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Provider Name | SERGIO ANDRES GOMEZ
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Gender | Male
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 8 CORNISH CT
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City | DIX HILLS
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State | NY
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Zip | 11746-6002
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Country | US
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Telephone | 347-432-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GREENE AVE STE 2A
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City | AMITYVILLE
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State | NY
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Zip | 11701-2964
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Country | US
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Telephone | 516-902-2480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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