Provider Demographics
NPI:1649948837
Name:GAO, TOBIAS (RPH)
Entity type:Individual
Prefix:DR
First Name:TOBIAS
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 103RD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-2013
Mailing Address - Country:US
Mailing Address - Phone:646-642-0943
Mailing Address - Fax:
Practice Address - Street 1:48-11 SKILLMAN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-729-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist