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General NPI Number Information
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NPI Number | 1932113495
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Entity Type | Individual
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Provider Name | EUGENIA T GAMBOA MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 615 W 173RD ST. SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-305-5586
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Fax | 212-305-2811
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Provider Business Mailing Address
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Address Line | 615 W 173RD ST. SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-568-0100
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Fax | 212-568-0144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 111280
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License Number State | NY
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