Provider Demographics
NPI:1407118979
Name:GOMEZ, MARIA MAGDALENA (MS)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MAGDALENA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3130
Mailing Address - Country:US
Mailing Address - Phone:203-720-9437
Mailing Address - Fax:203-720-9437
Practice Address - Street 1:2625 E 14TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3973
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1463408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407118979OtherSPECIALIST