Provider Demographics
NPI:1801585146
Name:GAMBLE, JOANNE MARIA (CRPA)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIA
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5555
Mailing Address - Country:US
Mailing Address - Phone:718-896-3400
Mailing Address - Fax:
Practice Address - Street 1:15705 ROCKAWAY BLVD # 2A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4841
Practice Address - Country:US
Practice Address - Phone:313-801-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
NYCRPA-5480175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist