Basic Information
| Provider Information | |||||||||
| NPI: | 1801904560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMES | ||||||||
| FirstName: | DOMINIC | ||||||||
| MiddleName: | SUCCOUR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 E HARTSDALE AVE | ||||||||
| Address2: | APT 5T | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105302725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146072411 | ||||||||
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| Practice Location | |||||||||
| Address1: | GRASSLAND ROAD | ||||||||
| Address2: | |||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 503008 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.