Provider Demographics
NPI:1497825129
Name:GOMEZ, MERY CONCEPCION (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MERY
Middle Name:CONCEPCION
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SPLIT ROCK RD
Mailing Address - Street 2:NY
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3109
Mailing Address - Country:US
Mailing Address - Phone:914-738-0048
Mailing Address - Fax:
Practice Address - Street 1:3000 MARCUS AVE STE 2W15
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1005
Practice Address - Country:US
Practice Address - Phone:855-201-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02180830Medicaid
NY02180830Medicaid
NY5050B1Medicare ID - Type Unspecified