Individual
JUAN A GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS. SP. TEACHER
Contact information
Practice address
1575 ALLERTON AVE, BRONX, NY 10469-6132
(347) 879-7513
(347) 879-7513
Mailing address
1575 ALLERTON AVE, BRONX, NY 10469-6132
(347) 879-7513
(347) 879-7513
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
17
NY
Other
Enumeration date
06/02/2009
Last updated
06/02/2009
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