Provider Demographics
NPI:1144372293
Name:GALAN, ANTONIO (PT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:GALAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2925
Mailing Address - Country:US
Mailing Address - Phone:212-245-5259
Mailing Address - Fax:
Practice Address - Street 1:664 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2925
Practice Address - Country:US
Practice Address - Phone:212-245-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJI-00001061225100000X
NY015279-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00614Q01Medicare ID - Type Unspecified