MEDICARE: JENNIFER KAREN GAMBINO

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	103K00000X	Behavior Analyst	1-17-27646	NJ

General Provider Information

NPI Number	:	1396189312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KAREN GAMBINO

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 HALF MILE RD
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-6749
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	04/21/2013
Last Update Date	:	02/15/2021

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