Provider Demographics
NPI:1558167239
Name:GOMES, MANISHA
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:GOMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BEACON LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4505
Mailing Address - Country:US
Mailing Address - Phone:516-710-1488
Mailing Address - Fax:
Practice Address - Street 1:29 BEACON LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4505
Practice Address - Country:US
Practice Address - Phone:516-710-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist