Provider Demographics
NPI:1588799209
Name:GAMBETTA, LOUIS ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ANTHONY
Last Name:GAMBETTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PATERSON AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-5627
Mailing Address - Country:US
Mailing Address - Phone:973-785-3334
Mailing Address - Fax:973-785-7760
Practice Address - Street 1:275 PATERSON AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-5627
Practice Address - Country:US
Practice Address - Phone:973-785-3334
Practice Address - Fax:973-785-7760
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002231213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6966900Medicaid
NJP368868OtherOXFORD
NJ2K1288OtherACS HEALTHNET
NJ8292244OtherCIGNA
NJP368868OtherOXFORD
NJU49691Medicare UPIN
NJGA769784Medicare ID - Type Unspecified