Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 118764 | NY |
NPI | 1417029810 |
---|---|
Provider Name | Alicia E Gomensoro |
First Address | Staten Island, NY 10305-2816 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |