Healthcare Provider Details

I. General information

NPI: 1588896211
Provider Name (Legal Business Name): GALAEI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CHESTNUT ST 5TH FLOOR
PHILADELPHIA PA
19107-4101
US

IV. Provider business mailing address

1207 CHESTNUT ST 5TH FLOOR
PHILADELPHIA PA
19107-4101
US

V. Phone/Fax

Practice location:
  • Phone: 215-581-1822
  • Fax: 215-851-1775
Mailing address:
  • Phone: 215-581-1822
  • Fax: 215-851-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS M MORALES MITTI
Title or Position: MEDICAL CASE MANAGER
Credential: BA
Phone: 215-851-1853