Healthcare Provider Details

I. General information

NPI: 1629956875
Provider Name (Legal Business Name): GABRIELLA PANOBIANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-02 PARMELEE AVE
FAIR LAWN NJ
07410-1915
US

IV. Provider business mailing address

15-02 PARMELEE AVE
FAIR LAWN NJ
07410-1915
US

V. Phone/Fax

Practice location:
  • Phone: 917-435-3417
  • Fax:
Mailing address:
  • Phone: 917-435-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number26NR22127300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: