Provider Demographics
NPI:1124366141
Name:GOMEZ, ANGELA
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SOUTH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4814
Mailing Address - Country:US
Mailing Address - Phone:845-485-3066
Mailing Address - Fax:845-485-1693
Practice Address - Street 1:201 SOUTH AVE STE 103
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4814
Practice Address - Country:US
Practice Address - Phone:845-485-3066
Practice Address - Fax:845-485-1693
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator