Provider Demographics
NPI:1023736253
Name:DG HERITAGE MEDICAL SERVICES ,LLC
Entity type:Organization
Organization Name:DG HERITAGE MEDICAL SERVICES ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-226-1776
Mailing Address - Street 1:110 CHESTNUT RIDGE RD # 335
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 KANE CONCOURSE STE 601
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2044
Practice Address - Country:US
Practice Address - Phone:917-226-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty