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General NPI Number Information
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NPI Number | 1861865404
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Entity Type | Individual
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Provider Name | PHOOWANAI GAMBINO RDN, CDN
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Gender | Male
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 33-41 NEWARK ST FL 5
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City | HOBOKEN
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State | NJ
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Zip | 07030-5627
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Country | US
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Telephone | 917-647-1665
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Fax | 201-473-5812
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Provider Business Mailing Address
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Address Line | 7917 32ND AVE # 1
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City | EAST ELMHURST
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State | NY
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Zip | 11370-1831
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Country | US
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Telephone | 917-647-1665
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI200001566
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1101790
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License Number State | NY
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