Basic Information
| Provider Information | |||||||||
| NPI: | 1235222936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALARNEAU | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | JULES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453337575 | ||||||||
| FaxNumber: | 8453337202 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453337575 | ||||||||
| FaxNumber: | 8453337202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 210862 | NY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 02053170 | 05 | NY | MEDICAID | 210862-9W | 01 | WORKERS COMPENSATION NUMBER | OTHER |