Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 209828 | NY |
NPI | 1053392472 |
---|---|
Provider Name | Tessa Gomez |
First Address | Philadelphia, PA 19195-2433 |
Second Address | New York, NY 10003-3314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 18/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01813996 | (05) | NY |
G66738 | (02) |