Provider Demographics
NPI:1346439031
Name:GALSTIAN, EVA
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:GALSTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADWAY 1702
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4400
Mailing Address - Country:US
Mailing Address - Phone:917-409-7575
Mailing Address - Fax:917-720-9037
Practice Address - Street 1:150 BROADWAY 1702
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4400
Practice Address - Country:US
Practice Address - Phone:917-409-7575
Practice Address - Fax:917-720-9037
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03292880Medicaid
NY03292880Medicaid
A100060791Medicare Oscar/Certification