MEDICARE: DR. BRIAN SCOTT GALLER D.O.

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	207R00000X	Internal Medicine Physician	266075	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	5101018102	MI
3	207RI0011X	Interventional Cardiology Physician	266075	NY
4	207R00000X	Internal Medicine Physician	5101018102	MI
5	207RC0000X	Cardiovascular Disease Physician	266075	NY

General Provider Information

NPI Number	:	1629278833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN SCOTT GALLER D.O.

Provider Business Mailing Address
First Line	:	850 HICKSVILLE RD
Second Line	:	SUITE 104
City	:	SEAFORD
State	:	NY
Zip	:	11783-1300
Country	:	US
Telephone Number	:	516-798-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 BROADWAY STE A
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2731
Country	:	US
Telephone Number	:	631-264-2424
Fax Number	:

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	03/11/2021

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