Individual provider Active NPI

Phoowanai Gambino, RDN, CDN

  • Registered Dietitian
  • Hoboken, NJ
National Provider Identifier
1861865404
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1101790 Issued in NY
Practice address
33-41 Newark St FL 5
Hoboken, NJ 07030-5627
Phone
(917) 647-1665
Fax
(201) 473-5812
NPI assigned
Nov 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DI200001566 DC
Registered Dietitian 133V00000X 1101790 NY Primary

Addresses

Primary practice location

33-41 Newark St FL 5
Hoboken, NJ 07030-5627

Mailing address

7917 32ND Ave # 1
East Elmhurst, NY 11370-1831
Phone (917) 647-1665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DI200001566DCMDRegistered Dietitian
1101790NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Fig Health, Inc Dietitian, Registered Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1861865404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7917 32ND AVE # 1",
            "city": "EAST ELMHURST",
            "state": "NY",
            "postal_code": "113701831",
            "telephone_number": "917-647-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-41 NEWARK ST FL 5",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070305627",
            "telephone_number": "917-647-1665",
            "fax_number": "201-473-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBINO",
        "first_name": "PHOOWANAI",
        "name_prefix": "Mr.",
        "credential": "RDN, CDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-04",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "DC",
            "license": "DI200001566",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "1101790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.