1982364790 NPI number — ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS PLLC

Table of content: TINA MARIE GOMEZ (NPI 1376006841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982364790 NPI number — ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982364790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 FLOCEE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON BAYS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11946-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-309-3040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-309-3040
Provider Business Practice Location Address Fax Number:
631-779-2168
Provider Enumeration Date:
12/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MOGAN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-309-3040

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043643992 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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