Provider Demographics
NPI:1699222109
Name:GOMEZ, GABRIELLA ROA (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROA
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 1:34202 TOWN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1594
Mailing Address - Country:US
Mailing Address - Phone:917-657-7682
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:BRONX
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-518-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY315789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program