Provider Demographics
NPI:1932113495
Name:GAMBOA, EUGENIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:T
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 173RD ST.
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-568-0100
Mailing Address - Fax:212-568-0144
Practice Address - Street 1:615 W 173RD ST.
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-5586
Practice Address - Fax:212-305-2811
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1112802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D39044Medicare UPIN
318292Medicare PIN
NYD39044Medicare UPIN