Individual
JOHN PAUL GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
10 BENTON AVE, MIDDLETOWN, NY 10940-5177
(845) 563-8000
Mailing address
2570 ROUTE 9W STE 10, CORNWALL, NY 12518-1370
(845) 220-3100
(845) 534-2940
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
708063
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402672
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04864013
—
NY
Enumeration date
08/04/2017
Last updated
07/24/2019
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