Provider Demographics
NPI:1811547896
Name:GOMEZ, JOSUE E (AGNP-C)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43 CROSSWAYS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2002
Mailing Address - Country:US
Mailing Address - Phone:516-938-3000
Mailing Address - Fax:516-938-3239
Practice Address - Street 1:43 CROSSWAYS PARK DR W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2002
Practice Address - Country:US
Practice Address - Phone:516-938-3000
Practice Address - Fax:516-938-3239
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF309217363LA2200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine