Provider Demographics
NPI:1629802459
Name:GAMEZ, ENRIQUE JOSE
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:GAMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AMBERSON AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3613
Mailing Address - Country:US
Mailing Address - Phone:917-741-6066
Mailing Address - Fax:
Practice Address - Street 1:30 AMBERSON AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3613
Practice Address - Country:US
Practice Address - Phone:917-741-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1814164241222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist