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General NPI Number Information
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NPI Number | 1467369777
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Entity Type | Individual
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Provider Name | NICHOLAS GOMEZ
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Gender | Male
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 37 RIDER AVE
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City | PATCHOGUE
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State | NY
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Zip | 11772-3915
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Country | US
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Telephone | 631-563-4550
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Fax | 631-563-4554
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Provider Business Mailing Address
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Address Line | 170 EARLE AVE
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City | LYNBROOK
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State | NY
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Zip | 11563-2642
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Country | US
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Telephone | 516-678-3650
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Fax | 516-678-3654
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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