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NPI Code Detail

MEDICARE: KERRIANN GAMBINO M.A.

MEDICARE: KERRIANN GAMBINO M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist983770001NY

General Provider Information

NPI Number : 1609271196
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRIANN GAMBINO M.A.
Provider Business Mailing Address
First Line : 61 WELLINGTON RD
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-4149
Country : US
Telephone Number : 516-385-5424
Fax Number :
Provider Business Practice Location Address
First Line : 61 WELLINGTON RD
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-4149
Country : US
Telephone Number : 516-385-5424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2014
Last Update Date : 10/27/2014

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Directions to “ KERRIANN GAMBINO M.A.” Practice Location

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