Healthcare Provider Details

I. General information

NPI: 1336052687
Provider Name (Legal Business Name): GILBERTO ANTONIO WARD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E 176TH ST FL 2
BRONX NY
10460-4617
US

IV. Provider business mailing address

770 E 176TH ST FL 2
BRONX NY
10460-4617
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-8908
  • Fax: 914-303-5012
Mailing address:
  • Phone: 718-466-8908
  • Fax: 914-303-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: