Provider Demographics
NPI:1619245628
Name:GOMEZ, MEAGHAN MCENTEE (APN)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:MCENTEE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:CATHLEENA
Other - Last Name:MCENTEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:515 E 72ND ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4052
Mailing Address - Country:US
Mailing Address - Phone:281-660-2028
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:281-660-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX725188363L00000X
NYF309052-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304487701Medicaid
TX304487701Medicaid