Provider Demographics
NPI:1366036782
Name:GB RN PC
Entity Type:Organization
Organization Name:GB RN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALO
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-923-3001
Mailing Address - Street 1:33 WALT WHITMAN RD STE 232
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4293
Mailing Address - Country:US
Mailing Address - Phone:631-923-3001
Mailing Address - Fax:631-923-1052
Practice Address - Street 1:33 WALT WHITMAN RD STE 232
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4293
Practice Address - Country:US
Practice Address - Phone:631-923-3001
Practice Address - Fax:631-923-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty