Healthcare Provider Details

I. General information

NPI: 1598831612
Provider Name (Legal Business Name): SHANE M GALAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 N. PARK AVE.
ROCKVILLE CENTRE NY
11570-4106
US

IV. Provider business mailing address

84 N PARK AVE
ROCKVILLE CENTRE NY
11570-4106
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-2423
  • Fax: 516-766-2432
Mailing address:
  • Phone: 516-766-2423
  • Fax: 516-766-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number005774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: