Healthcare Provider Details

I. General information

NPI: 1073243317
Provider Name (Legal Business Name): GALILEO MEDICAL GROUP CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY PH
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

V. Phone/Fax

Practice location:
  • Phone: 347-943-8131
  • Fax:
Mailing address:
  • Phone: 347-943-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 347-943-8131