Provider Demographics
NPI:1275772386
Name:GOMEZ, GIANCARLO (MD)
Entity Type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ENGLE ST APT H2
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2414
Mailing Address - Country:US
Mailing Address - Phone:347-924-4256
Mailing Address - Fax:
Practice Address - Street 1:275 ENGLE ST APT H2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2414
Practice Address - Country:US
Practice Address - Phone:347-924-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program