Provider Demographics
NPI:1063867885
Name:GOMES, GLENN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MONTIETH ST APT 756
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4764
Mailing Address - Country:US
Mailing Address - Phone:732-610-6127
Mailing Address - Fax:
Practice Address - Street 1:250 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3123
Practice Address - Country:US
Practice Address - Phone:201-383-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10418200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine