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General NPI Number Information
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NPI Number | 1639562226
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Entity Type | Organization
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Legal Business Name | CAMERON L. GOMEZ, PT
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 1 COLUMBUS PL APT. S19B
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City | NEW YORK
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State | NY
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Zip | 10019-8201
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Country | US
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Telephone | 212-594-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COLUMBUS PL APT. S19B
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City | NEW YORK
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State | NY
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Zip | 10019-8201
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Country | US
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Telephone | 212-594-3170
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Fax |
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Authorized Official
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Title or Position | FOUNDER & THERAPIST
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Name | MR. CAMERON LUCIO GOMEZ
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Credential | DPT, COMT
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Telephone | 212-594-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 030551
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License Number State | NY
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