Basic Information
| Provider Information | |||||||||
| NPI: | 1811547896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | JOSUE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 CROSSWAYS PARK DR W | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117972002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 CROSSWAYS PARK DR W | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117972002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2019 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F309217 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 207R00000X | F309217 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.