Basic Information
| Provider Information | |||||||||
| NPI: | 1275659815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAMBUZZA | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEVERSEN | ||||||||
| OtherFirstName: | EVA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 55 2B RICHMOND BLVD | ||||||||
| Address2: | |||||||||
| City: | RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117793402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315803806 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 111 BEACH DR | ||||||||
| Address2: | OUR LADY OF CONSOLATION | ||||||||
| City: | W ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315871600 | ||||||||
| FaxNumber: | 6315875960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 2692881 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.