MEDICARE: GALIA THERESA AUSTIN-LEON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	216679-1	NY

General Provider Information

NPI Number	:	1225022742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALIA THERESA AUSTIN-LEON MD

Provider Business Mailing Address
First Line	:	18 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2404
Country	:	US
Telephone Number	:	917-756-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 28TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	646-939-7245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	05/06/2020

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