Provider Demographics
NPI:1154861540
Name:GAL, NELLY TIELES (PA)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:TIELES
Last Name:GAL
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4 LAFAYETTE CT
Mailing Address - Street 2:APT. C
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3036
Mailing Address - Country:US
Mailing Address - Phone:845-896-9200
Mailing Address - Fax:845-896-3262
Practice Address - Street 1:4 LAFAYETTE CT
Practice Address - Street 2:APT. C
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3036
Practice Address - Country:US
Practice Address - Phone:845-896-9200
Practice Address - Fax:845-896-3262
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
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Provider Licenses
StateLicense IDTaxonomies
NY020682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant