Healthcare Provider Details

I. General information

NPI: 1164385019
Provider Name (Legal Business Name): JUSTIN B GALYNSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BRIGHTWATER AVE APT 4K
BROOKLYN NY
11235-5928
US

IV. Provider business mailing address

1311 BRIGHTWATER AVE APT 4K
BROOKLYN NY
11235-5928
US

V. Phone/Fax

Practice location:
  • Phone: 646-427-8157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number920837637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: