Provider Demographics
NPI:1801053715
Name:GOMEZ-VASQUEZ., RICARDO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANTONIO
Last Name:GOMEZ-VASQUEZ.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:A
Other - Last Name:GOMEZ-VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:520 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4147
Mailing Address - Country:US
Mailing Address - Phone:908-587-9300
Mailing Address - Fax:908-587-1901
Practice Address - Street 1:550 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1530
Practice Address - Country:US
Practice Address - Phone:973-482-4697
Practice Address - Fax:973-482-0893
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267260207Q00000X
TXN7265207Q00000X
CT48241207R00000X
NJ25MA09202200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09202200OtherNJ MEDICAL LICENSE
NJ0331651Medicaid
NY267260OtherNEW YORK MEDICAL LICENSE
CT48241OtherCONNECTICUT MEDICAL LICENCE
TXN7265OtherTEXAS MEDICAL LICENSE