Healthcare Provider Details

I. General information

NPI: 1487286944
Provider Name (Legal Business Name): ELIZABETH GALLEGO LM MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST STE B
SPRING VALLEY NY
10977-3702
US

IV. Provider business mailing address

265 N MAIN ST STE B
SPRING VALLEY NY
10977-3702
US

V. Phone/Fax

Practice location:
  • Phone: 845-356-1430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH GALLEGO
Title or Position: OWNER
Credential: CM
Phone: 845-356-1430