Healthcare Provider Details

I. General information

NPI: 1790741965
Provider Name (Legal Business Name): ROBERT J GAMBINO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST # C3
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

100 HIGH ST # C3
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-7600
  • Fax: 716-859-2885
Mailing address:
  • Phone: 716-859-7600
  • Fax: 716-859-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number007620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: