Healthcare Provider Details

I. General information

NPI: 1568388569
Provider Name (Legal Business Name): KEVIN GAMGORT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 TERRACE PL
BROOKLYN NY
11218-1013
US

IV. Provider business mailing address

103 SULLIVAN ST APT 3C
NEW YORK NY
10012-3687
US

V. Phone/Fax

Practice location:
  • Phone: 973-476-3183
  • Fax:
Mailing address:
  • Phone: 973-476-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07475800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: