Provider Demographics
NPI:1609260702
Name:GOMEZ NEUROLOGY
Entity Type:Organization
Organization Name:GOMEZ NEUROLOGY
Other - Org Name:GOMEZ NEUROLOGY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-285-0782
Mailing Address - Street 1:1252 KEYES AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5728
Mailing Address - Country:US
Mailing Address - Phone:518-285-0782
Mailing Address - Fax:855-420-6025
Practice Address - Street 1:110 WOLF RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1244
Practice Address - Country:US
Practice Address - Phone:518-650-2090
Practice Address - Fax:855-420-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473187261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty