MEDICARE: PAUL ROBERT GALSTIAN O.D

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	152W00000X	Optometrist	T005219	NY

General Provider Information

NPI Number	:	1568576296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ROBERT GALSTIAN O.D

Provider Business Mailing Address
First Line	:	825 E GATE BLVD
Second Line	:	STE 111
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-2124
Country	:	US
Telephone Number	:	516-804-5200
Fax Number	:	516-240-6540

Provider Business Practice Location Address
First Line	:	2860 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3114
Country	:	US
Telephone Number	:	516-593-7709
Fax Number	:	516-887-8380

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	09/09/2019

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