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Provider Information for 1699892554

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MR. AMBROSIO NARVASA GOMEZ P.T.

Gender: MALE

Individual NPI: 1699892554

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1699892554
Enumeration Date 2007-03-24
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3239 73RD ST
EAST ELMHURST, NY 11370-1705
United States

Phone: 718-478-2864 | Fax:
View Map External Link
Primary Practice Address 7312 35TH AVE SUITE AA
JACKSON HEIGHTS, NY 11372-4241
United States

Phone: 718-458-0616 | Fax: 718-458-0525
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID NY 02557019
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 225100000X - Physical Therapist NY 024579