Healthcare Provider Details

I. General information

NPI: 1114428141
Provider Name (Legal Business Name): JOHNAE PATRICE GALLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 02/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NEW SCOTLAND AVE
ALBANY NY
12208-1928
US

IV. Provider business mailing address

1 RAPP RD
ALBANY NY
12203-4491
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-7858
  • Fax:
Mailing address:
  • Phone: 518-867-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: