Provider Demographics
NPI:1033435573
Name:GAMBLE, LAWRENCE C (LAC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:C
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11923 191ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3622
Mailing Address - Country:US
Mailing Address - Phone:646-296-1765
Mailing Address - Fax:
Practice Address - Street 1:135 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4748
Practice Address - Country:US
Practice Address - Phone:646-296-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2407-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist