Provider Demographics
NPI:1609387000
Name:GUMBAN, STEPHANIE INGRID B (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE INGRID
Middle Name:B
Last Name:GUMBAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LOWER NOTCH RD # A3
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1802
Mailing Address - Country:US
Mailing Address - Phone:973-837-6600
Mailing Address - Fax:
Practice Address - Street 1:201 LOWER NOTCH RD # A3
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1802
Practice Address - Country:US
Practice Address - Phone:973-837-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA017587002081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609387000OtherNPI