Provider Demographics
NPI:1861865404
Name:GAMBINO, PHOOWANAI (RDN, CDN)
Entity type:Individual
Prefix:MR
First Name:PHOOWANAI
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 32ND AVE # 1
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1831
Mailing Address - Country:US
Mailing Address - Phone:917-647-1665
Mailing Address - Fax:
Practice Address - Street 1:33-41 NEWARK ST FL 5
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5627
Practice Address - Country:US
Practice Address - Phone:917-647-1665
Practice Address - Fax:201-473-5812
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI200001566133V00000X
NY1101790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered