MEDICARE: MARCELO GOMEZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1396948717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELO GOMEZ MSW

Provider Business Mailing Address
First Line	:	25 POMPTON AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2941
Country	:	US
Telephone Number	:	973-857-9030
Fax Number	:	973-857-9036

Provider Business Practice Location Address
First Line	:	25 POMPTON AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2941
Country	:	US
Telephone Number	:	973-857-9030
Fax Number	:	973-857-9036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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