Provider Demographics
NPI:1376846493
Name:GAMBINO, MARYANN
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 RADIO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3526
Mailing Address - Country:US
Mailing Address - Phone:631-849-3617
Mailing Address - Fax:631-849-3617
Practice Address - Street 1:270 RADIO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3526
Practice Address - Country:US
Practice Address - Phone:631-849-3617
Practice Address - Fax:631-849-3617
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395349-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse