Basic Information
| Provider Information | |||||||||
| NPI: | 1619436029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GALILEA MEDICAL GROUP, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 BLEECKER ST # 151 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100122410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 64 BLEECKER ST # 151 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100122410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023131584 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8007314254 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.