MEDICARE: DR. DAVID GAMBURG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	25MA06745800	NJ
2	208VP0000X	Pain Medicine Physician	1984401	NY

General Provider Information

NPI Number	:	1134120298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GAMBURG MD

Provider Business Mailing Address
First Line	:	255 EAST MAIN STREET
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446
Country	:	US
Telephone Number	:	201-326-4777
Fax Number	:	201-391-1196

Provider Business Practice Location Address
First Line	:	600C LAKE ST
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1360
Country	:	US
Telephone Number	:	201-326-4777
Fax Number	:	201-391-1196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/14/2024

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