Organization
CONSTRACTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUERLINE D GOMEZ MS (SPECIAL EDUCATION TEACHER)
(347) 962-2006
Entity
Organization
Contact information
Practice address
3 GEORGIA ST, VALLEY STREAM, NY 11580-2224
(347) 962-2006
Mailing address
PO BOX 82, VALLEY STREAM, NY 11582-0082
(347) 962-2006
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
824950
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103TE1000X
SPECIAL EDUCATION TEACHER
NY
Enumeration date
09/10/2014
Last updated
09/10/2014
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