Healthcare Provider Details

I. General information

NPI: 1487706503
Provider Name (Legal Business Name): MARLENE DONNA NAGLER GALVIS R.N.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY FL 4
NEW YORK NY
10003-9580
US

IV. Provider business mailing address

1474 TAFT CT
EAST MEADOW NY
11554-4425
US

V. Phone/Fax

Practice location:
  • Phone: 212-443-1173
  • Fax: 212-443-1167
Mailing address:
  • Phone: 516-489-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3600201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: