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General NPI Number Information
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NPI Number | 1871885574
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Entity Type | Organization
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Legal Business Name | GALLERIA MEDICAL GROUP
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 115 E 57TH ST SUITE 610
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City | NEW YORK
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State | NY
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Zip | 10022-2049
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Country | US
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Telephone | 212-644-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E 57TH ST SUITE 610
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City | NEW YORK
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State | NY
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Zip | 10022-2049
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Country | US
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Telephone | 212-644-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATASHA FUKSINA
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Credential | MD
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Telephone | 212-644-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 195930
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 091891
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 222934
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License Number State | NY
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