Provider Demographics
NPI:1750871034
Name:GOMOS, MARICRIS SONER
Entity type:Individual
Prefix:
First Name:MARICRIS
Middle Name:SONER
Last Name:GOMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 81ST ST APT B48
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1349
Mailing Address - Country:US
Mailing Address - Phone:646-945-5950
Mailing Address - Fax:
Practice Address - Street 1:4015 81ST ST APT B48
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1349
Practice Address - Country:US
Practice Address - Phone:646-945-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant