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General NPI Number Information
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NPI Number | 1275710329
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Entity Type | Organization
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Legal Business Name | PAUL T GAMBARDELLA DPM
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 329 MAIN ST UNIT 110
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City | WALLINGFORD
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State | CT
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Zip | 06492-2279
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Country | US
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Telephone | 203-265-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 329 MAIN ST UNIT 110
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City | WALLINGFORD
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State | CT
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Zip | 06492-2279
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Country | US
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Telephone | 203-265-6677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL T GAMBARDELLA
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Credential |
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Telephone | 203-265-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 000547
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License Number State | CT
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