Provider Demographics
NPI:1962028761
Name:GAMBAN, NICOLE IRIS ANTILIGANDO (DPT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE IRIS
Middle Name:ANTILIGANDO
Last Name:GAMBAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 LEXINGTON AVE
Mailing Address - Street 2:26TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-951-1483
Mailing Address - Fax:888-646-5967
Practice Address - Street 1:369 LEXINGTON AVE
Practice Address - Street 2:26TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-951-1483
Practice Address - Fax:888-646-5967
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044765-01225100000X
NY044765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty