Provider Demographics
NPI:1023722808
Name:GOMEZ, FERNANDO ENRIQUE II (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ENRIQUE
Last Name:GOMEZ
Suffix:II
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:ENRIQUE
Other - Last Name:GOMEZ
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:814 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3302
Mailing Address - Country:US
Mailing Address - Phone:551-655-2404
Mailing Address - Fax:
Practice Address - Street 1:6612-18 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-854-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02150100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist