Healthcare Provider Details

I. General information

NPI: 1396181475
Provider Name (Legal Business Name): MR. RICHARD ANTHONY GALARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 ROUTE 9W
RAVENA NY
12143-2850
US

IV. Provider business mailing address

2524 ROUTE 9W
RAVENA NY
12143-2850
US

V. Phone/Fax

Practice location:
  • Phone: 518-756-7390
  • Fax: 518-756-8030
Mailing address:
  • Phone: 518-756-7390
  • Fax: 518-756-8030

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: