Provider Demographics
NPI:1528153400
Name:GALUSHA, JILL (RPAC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GALUSHA
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1118
Mailing Address - Country:US
Mailing Address - Phone:518-374-5353
Mailing Address - Fax:518-377-2517
Practice Address - Street 1:135 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4511
Practice Address - Country:US
Practice Address - Phone:518-792-0994
Practice Address - Fax:518-745-5946
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300005306Medicaid
NY346838OtherMVP
NY346838OtherMVP