Provider Demographics
NPI:1962062430
Name:GAMBINO, MATTHEW SAMUEL (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SAMUEL
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1754
Mailing Address - Country:US
Mailing Address - Phone:856-678-4800
Mailing Address - Fax:856-678-3630
Practice Address - Street 1:48 N BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1754
Practice Address - Country:US
Practice Address - Phone:856-678-4800
Practice Address - Fax:856-678-3630
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00693100152W00000X
PAOEG003556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist