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General NPI Number Information
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NPI Number | 1831594944
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Entity Type | Individual
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Provider Name | GAETANO L CAMBRIA PAC
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Gender | Male
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 51 N 39TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-662-9493
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 ROUTE 66 3RD FL
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City | NEPTUNE
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State | NJ
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Zip | 07753-2645
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Country | US
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Telephone | 732-807-0880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00417600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA059672
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00417600
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License Number State | NJ
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