Basic Information
| Provider Information | |||||||||
| NPI: | 1750348900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMES | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO, CMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 BRASS CASTLE RD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078826309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088351910 | ||||||||
| FaxNumber: | 9088351924 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 COVENTRY CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084549902 | ||||||||
| FaxNumber: | 9084549905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB064321 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS009085L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2105913 | 01 | NJ | AETNA | OTHER | 223733353 | 01 | NJ | HORIZON | OTHER | 7387601 | 05 | NJ | MEDICAID |