Provider Demographics
NPI:1285996702
Name:GAMBERG, KERI BETH (MS)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:BETH
Last Name:GAMBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 BOGUS RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1306
Mailing Address - Country:US
Mailing Address - Phone:203-448-6428
Mailing Address - Fax:
Practice Address - Street 1:91 BOGUS RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-1306
Practice Address - Country:US
Practice Address - Phone:203-448-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483219931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist