=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043732548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE ANGELA GALO FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2017
-----------------------------------------------------
Last Update Date | 07/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 OLD COUNTRY RD STE 278
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-877-0977
-----------------------------------------------------
Fax | 516-294-6861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 3RD ST
-----------------------------------------------------
City | GARDEN CITY PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-532-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 341877
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------