Provider Demographics
NPI:1851134035
Name:D GOMEZ PRACTICE LLC
Entity type:Organization
Organization Name:D GOMEZ PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, PMHNP-BC
Authorized Official - Phone:973-919-5975
Mailing Address - Street 1:100 E PALISADE AVE APT D42
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3072
Mailing Address - Country:US
Mailing Address - Phone:973-919-5975
Mailing Address - Fax:973-528-3204
Practice Address - Street 1:100 E PALISADE AVE APT D42
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3072
Practice Address - Country:US
Practice Address - Phone:973-919-5975
Practice Address - Fax:973-528-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty