Provider Demographics
NPI:1538201017
Name:GALVEZ, CARMEN A (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EAST 74 ST
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-861-6663
Mailing Address - Fax:212-734-6622
Practice Address - Street 1:20 EAST 74TH ST
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-861-6663
Practice Address - Fax:212-734-6622
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121489207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00227867Medicaid
B12968Medicare UPIN
NY00227867Medicaid