Basic Information
Provider Information | |||||||||
NPI: | 1043732548 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GALO | ||||||||
FirstName: | MICHELE | ||||||||
MiddleName: | ANGELA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 89 3RD ST | ||||||||
Address2: |   | ||||||||
City: | GARDEN CITY PARK | ||||||||
State: | NY | ||||||||
PostalCode: | 110404411 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5165326100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 OLD COUNTRY RD STE 278 | ||||||||
Address2: |   | ||||||||
City: | MINEOLA | ||||||||
State: | NY | ||||||||
PostalCode: | 115014298 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5168770977 | ||||||||
FaxNumber: | 5162946861 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2017 | ||||||||
LastUpdateDate: | 07/17/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 341877 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.