Provider Demographics
NPI:1831408855
Name:GOMEZ, IRENE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HEMPSTEAD TPKE.
Mailing Address - Street 2:PRIMARY HEALTHCARE PLUS
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1411
Mailing Address - Country:US
Mailing Address - Phone:516-352-8300
Mailing Address - Fax:516-352-8331
Practice Address - Street 1:1209 HEMPSTEAD TPKE
Practice Address - Street 2:PRIMARY HEALTHCARE PLUS
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010
Practice Address - Country:US
Practice Address - Phone:516-352-8300
Practice Address - Fax:516-352-8331
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant