Provider Demographics
NPI:1275659815
Name:GAMBUZZA, EVA (LPN)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:GAMBUZZA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:LEVERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 2B RICHMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3402
Mailing Address - Country:US
Mailing Address - Phone:631-580-3806
Mailing Address - Fax:
Practice Address - Street 1:111 BEACH DR
Practice Address - Street 2:OUR LADY OF CONSOLATION
Practice Address - City:W ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4960
Practice Address - Country:US
Practice Address - Phone:631-587-1600
Practice Address - Fax:631-587-5960
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2692881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse