Provider Demographics
NPI:1790741965
Name:GAMBINO, ROBERT J (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HIGH ST # C3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1126
Mailing Address - Country:US
Mailing Address - Phone:716-859-7600
Mailing Address - Fax:716-859-2885
Practice Address - Street 1:100 HIGH ST # C3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:718-859-7600
Practice Address - Fax:716-859-2885
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007620363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02081354Medicaid
NY02081354Medicaid