Healthcare Provider Details

I. General information

NPI: 1316209737
Provider Name (Legal Business Name): YVETTE GUMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 HORACE HARDING EXPY
BAYSIDE NY
11364-2227
US

IV. Provider business mailing address

22018 HORACE HARDING EXPY
BAYSIDE NY
11364-2227
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-0056
  • Fax: 718-229-5370
Mailing address:
  • Phone: 718-423-0056
  • Fax: 718-229-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: