Provider Demographics
NPI:1437149580
Name:GOMEZ, GERALDINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 OLD INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2603
Mailing Address - Country:US
Mailing Address - Phone:973-429-7474
Mailing Address - Fax:973-731-8381
Practice Address - Street 1:99 OLD INDIAN RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2603
Practice Address - Country:US
Practice Address - Phone:973-429-7474
Practice Address - Fax:973-731-8381
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2899701Medicaid
NJE53572Medicare UPIN
NJ2899701Medicaid