Healthcare Provider Details

I. General information

NPI: 1679124184
Provider Name (Legal Business Name): ELIZABETH GALLIGAN FELIX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST FL 5
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

1376 3RD AVE APT 4F
NEW YORK NY
10075-0478
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: