Provider Demographics
NPI:1538609607
Name:NG GOMEZON CORPORATION
Entity type:Organization
Organization Name:NG GOMEZON CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED. TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS SP EDUCATION
Authorized Official - Phone:646-662-7973
Mailing Address - Street 1:1575 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6132
Mailing Address - Country:US
Mailing Address - Phone:718-880-5358
Mailing Address - Fax:718-880-5358
Practice Address - Street 1:1575 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6132
Practice Address - Country:US
Practice Address - Phone:718-880-5358
Practice Address - Fax:718-880-5358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPEUTIC IMPRINTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty