Healthcare Provider Details

I. General information

NPI: 1134120298
Provider Name (Legal Business Name): DAVID GAMBURG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600C LAKE ST
RAMSEY NJ
07446-1360
US

IV. Provider business mailing address

255 EAST MAIN STREET
RAMSEY NJ
07446
US

V. Phone/Fax

Practice location:
  • Phone: 201-326-4777
  • Fax: 201-391-1196
Mailing address:
  • Phone: 201-326-4777
  • Fax: 201-391-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number1984401
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA06745800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: