Provider Demographics
NPI:1588553648
Name:GAMBOA, NORMAN HARVEY AYO (PT)
Entity type:Individual
Prefix:
First Name:NORMAN HARVEY
Middle Name:AYO
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MARGARET BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3216
Mailing Address - Country:US
Mailing Address - Phone:516-991-2318
Mailing Address - Fax:
Practice Address - Street 1:149 MARGARET BLVD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3216
Practice Address - Country:US
Practice Address - Phone:516-991-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist