Provider Demographics
NPI:1215438783
Name:TOMMY GALANIS MD PC
Entity type:Organization
Organization Name:TOMMY GALANIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-507-5800
Mailing Address - Street 1:3540 82ND ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5106
Mailing Address - Country:US
Mailing Address - Phone:718-507-5800
Mailing Address - Fax:718-507-1017
Practice Address - Street 1:3540 82ND ST STE 1D
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5106
Practice Address - Country:US
Practice Address - Phone:718-507-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265401208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03486220Medicaid