# NERISSA GUBALLA MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003984162
- **Authorized official:** DR. NERISSA SYLVIA GUBALLA MD (PRESIDENT)
- **Authorized official phone:** (212) 249-0900

## Contact information

- **Practice address:** 408 E 76TH ST, NEW YORK, NY 10021
- **Practice address phone:** (212) 249-0900
- **Practice address fax:** (212) 249-5277
- **Mailing address:** 408 E 76TH ST, NEW YORK, NY 10021
- **Mailing address phone:** (212) 249-0900
- **Mailing address fax:** (212) 249-5277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 220682 | NY | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 08/22/2020