Provider Demographics
NPI:1013305432
Name:CLAUDIO GOMEZ DPM LLC
Entity Type:Organization
Organization Name:CLAUDIO GOMEZ DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-755-5500
Mailing Address - Street 1:120 W 7TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1643
Mailing Address - Country:US
Mailing Address - Phone:908-755-5500
Mailing Address - Fax:908-271-4496
Practice Address - Street 1:401 US HIGHWAY 22 W
Practice Address - Street 2:UNIT 40 B
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3805
Practice Address - Country:US
Practice Address - Phone:908-756-5049
Practice Address - Fax:908-271-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00298900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0325091Medicaid
NJ0325091Medicaid