Provider Demographics
NPI:1073025839
Name:GAMBARDELLA, RON (PHD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:GAMBARDELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:REMSENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:11960-0860
Mailing Address - Country:US
Mailing Address - Phone:516-380-1457
Mailing Address - Fax:908-583-9997
Practice Address - Street 1:35 E BLANCKE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3180
Practice Address - Country:US
Practice Address - Phone:908-862-4404
Practice Address - Fax:908-583-9997
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYGAMBR1207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGAMBR1OtherNYS C OF Q