Active NPI
Luis Micheal Gomez, COTA
- Community Health Worker
- New York, NY
National Provider Identifier
1659551828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 003940-1
- Practice address
- 313 W 143Rd St
1A
New York, NY 10030-1203 - Phone
- (646) 773-3832
- NPI assigned
- Nov 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 003940-1 | NY | Primary |
Addresses
Primary practice location
313 W 143Rd St
1A
New York, NY 10030-1203
Mailing address
313 W 143Rd St
1A
New York, NY 10030-1203
Phone (646) 773-3832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003940-1 | NY | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194220800000",
"number": "1659551828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 W 143RD ST",
"address_2": "1A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100301203",
"telephone_number": "646-773-3832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 W 143RD ST",
"address_2": "1A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100301203",
"telephone_number": "646-773-3832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "LUIS",
"middle_name": "MICHEAL",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-05",
"last_updated": "2007-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "003940-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.