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General NPI Number Information
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NPI Number | 1861954315
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Entity Type | Individual
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Provider Name | ELIZABETH PEREZ GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 7733 BERGENLINE AVE
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-7134
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Country | US
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Telephone | 201-869-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 24 JONES ST APT 512
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City | NEWARK
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State | NJ
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Zip | 07103-3845
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Country | US
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Telephone | 561-853-5054
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-81180
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI03096200
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License Number State | NJ
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