Provider Demographics
NPI:1861648180
Name:CARLOS J. GOMEZ MD PA
Entity Type:Organization
Organization Name:CARLOS J. GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-823-2655
Mailing Address - Street 1:95 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3226
Mailing Address - Country:US
Mailing Address - Phone:201-823-2655
Mailing Address - Fax:201-823-1036
Practice Address - Street 1:95 W 50TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3226
Practice Address - Country:US
Practice Address - Phone:201-823-2655
Practice Address - Fax:201-823-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA22874302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55246Medicare UPIN
NJ451767Medicare PIN