Provider Demographics
NPI:1265654438
Name:GALINA RIVKIN INC
Entity Type:Organization
Organization Name:GALINA RIVKIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-770-1777
Mailing Address - Street 1:12131 DORSETT ROAD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043
Mailing Address - Country:US
Mailing Address - Phone:314-770-1777
Mailing Address - Fax:
Practice Address - Street 1:12131 DORSETT ROAD
Practice Address - Street 2:SUITE 123
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043
Practice Address - Country:US
Practice Address - Phone:314-770-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI23865Medicare UPIN