Provider Demographics
NPI:1184170029
Name:GOMATOS, ILIAS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ILIAS
Middle Name:
Last Name:GOMATOS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 95TH STREET
Mailing Address - Street 2:APT 21M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4007
Mailing Address - Country:US
Mailing Address - Phone:917-657-6366
Mailing Address - Fax:
Practice Address - Street 1:225 E 95TH STREET
Practice Address - Street 2:APT 21M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4007
Practice Address - Country:US
Practice Address - Phone:917-657-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program