Healthcare Provider Details

I. General information

NPI: 1467743252
Provider Name (Legal Business Name): TAMMY GALARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

545 PROSPECT PL APT 5E
BROOKLYN NY
11238-4269
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number081190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: