Provider Demographics
NPI:1023521218
Name:GAMBESKI, JACQUELINE AILEEN (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:AILEEN
Last Name:GAMBESKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1545
Mailing Address - Country:US
Mailing Address - Phone:203-913-9483
Mailing Address - Fax:
Practice Address - Street 1:4 CORPORATE DR STE 290
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6263
Practice Address - Country:US
Practice Address - Phone:203-452-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341643-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily