Healthcare Provider Details

I. General information

NPI: 1083811848
Provider Name (Legal Business Name): GALLOWAY INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PONDFIELD RD
BRONXVILLE NY
10708-3809
US

IV. Provider business mailing address

77 PONDFIELD RD
BRONXVILLE NY
10708-3809
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-4986
  • Fax: 914-337-6422
Mailing address:
  • Phone: 914-337-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1657751
License Number StateNY

VIII. Authorized Official

Name: DELLIS A GALLOWAY
Title or Position: MD
Credential:
Phone: 914-337-4986