Provider Demographics
NPI:1124102942
Name:TSUBOYAMA, GABRIEL KAZUO (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:KAZUO
Last Name:TSUBOYAMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:163 W 125TH ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 W 125TH ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4436
Practice Address - Country:US
Practice Address - Phone:212-961-8709
Practice Address - Fax:212-866-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1787582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02785371Medicaid
NY02785371Medicaid