Healthcare Provider Details

I. General information

NPI: 1356595474
Provider Name (Legal Business Name): MARIA ELAINE GAMBINO L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 FRENCH RD.
CHEEKTOWAGA NY
14227
US

IV. Provider business mailing address

338 AMHERST ST.
BUFFALO NY
14207
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-8021
  • Fax:
Mailing address:
  • Phone: 716-603-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number022103-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: