Provider Demographics
NPI:1417572074
Name:GOMEZ, RUTH (LICENSED NURSE)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNDERCLIFF AVE # 1
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1593
Mailing Address - Country:US
Mailing Address - Phone:201-679-4695
Mailing Address - Fax:
Practice Address - Street 1:500 UNDERCLIFF AVE # 1
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1593
Practice Address - Country:US
Practice Address - Phone:201-679-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26NP05896400164W00000X
NJ26NP05896400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse