Provider Demographics
NPI:1467185751
Name:AMOROSO, GABRIELLE
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:AMOROSO
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 1:225 COMMUNITY DR RM 110
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5506
Mailing Address - Country:US
Mailing Address - Phone:516-918-4800
Mailing Address - Fax:
Practice Address - Street 1:225 COMMUNITY DR RM 110
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5506
Practice Address - Country:US
Practice Address - Phone:516-918-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350151363LF0000X
NY702954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse