Provider Demographics
NPI:1033148184
Name:SAMUEL H GALIB - OPTHAMOLOGY ASSOC PC
Entity Type:Organization
Organization Name:SAMUEL H GALIB - OPTHAMOLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-0600
Mailing Address - Street 1:520 KING RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 KING RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1759
Practice Address - Country:US
Practice Address - Phone:610-644-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035144L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGA32064Medicare ID - Type Unspecified