Provider Demographics
NPI:1013398684
Name:FETSAK, GALYNA
Entity Type:Individual
Prefix:MRS
First Name:GALYNA
Middle Name:
Last Name:FETSAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GALYNA
Other - Middle Name:
Other - Last Name:CYRMACHEVSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:366 ONDERDONK AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1323
Mailing Address - Country:US
Mailing Address - Phone:646-886-9038
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:DEPT OF OBS & GYN, NORTH PAVILION-LOWER LEVEL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8660
Practice Address - Fax:516-663-7821
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298260-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology