Provider Demographics
NPI:1558592857
Name:GOMEZ, CAMERON L (PT,DPT, LAC, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:L
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PT,DPT, LAC, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W 11TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2211
Mailing Address - Country:US
Mailing Address - Phone:212-594-3170
Mailing Address - Fax:
Practice Address - Street 1:56 W 39TH ST
Practice Address - Street 2:APT 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3824
Practice Address - Country:US
Practice Address - Phone:646-590-7199
Practice Address - Fax:646-455-0143
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006342171100000X
NY030551225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports