Individual
ANDREA GOMEZ PEREIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
410 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776
(631) 642-1100
Mailing address
655 BELLE TERRE RD APT 39, PORT JEFFERSON, NY 11777-2410
(631) 942-8100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022423-1
NY
Other
Enumeration date
08/09/2018
Last updated
11/21/2019
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