Provider Demographics
NPI:1811007230
Name:GOMES, GERSON IVES (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSON
Middle Name:IVES
Last Name:GOMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189-11 CROCHERON AVENUE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2488
Mailing Address - Country:US
Mailing Address - Phone:171-853-9757
Mailing Address - Fax:171-893-9302
Practice Address - Street 1:18911 CROCHERON AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:171-853-9757
Practice Address - Fax:171-893-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130381207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease