Provider Demographics
NPI:1689601262
Name:GAMBINO, JOSEPH ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
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 1:29 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-887-2200
Mailing Address - Fax:516-887-2202
Practice Address - Street 1:29 BROADWAY
Practice Address - Street 2:2ND FL
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-887-2200
Practice Address - Fax:516-887-2202
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10987-8OtherWORKER'S COMP
NYC10987-8OtherWORKER'S COMP
V07835Medicare UPIN