Provider Demographics
NPI:1558381715
Name:GAMBINO, JOSEPH M (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-969-1540
Mailing Address - Fax:203-969-1539
Practice Address - Street 1:526 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-969-1540
Practice Address - Fax:203-969-1539
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001148111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1558381715OtherNPI
CT350000851Medicare ID - Type Unspecified
CT1558381715Medicare NSC