Provider Demographics
NPI:1386906865
Name:GAMBINO, NANCY ANNE (MS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:GAMBINO
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 1:6 LANGLEY CT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3416
Mailing Address - Country:US
Mailing Address - Phone:631-245-0258
Mailing Address - Fax:
Practice Address - Street 1:1363 VETERANS MEMORIAL HWY STE 8
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3046
Practice Address - Country:US
Practice Address - Phone:631-366-3876
Practice Address - Fax:631-366-3898
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324136901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist