Healthcare Provider Details

I. General information

NPI: 1053584607
Provider Name (Legal Business Name): GALANDENTALPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 BROADWAY APT 1A
NEW YORK NY
10031-5609
US

IV. Provider business mailing address

3440 BROADWAY APT 1A
NEW YORK NY
10031-5609
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-6555
  • Fax: 212-283-1211
Mailing address:
  • Phone: 212-283-6555
  • Fax: 212-283-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number046680-1
License Number StateNY

VIII. Authorized Official

Name: DR. MANUEL F GALAN JR.
Title or Position: DENTIST
Credential: DDS
Phone: 212-283-6555