Provider Demographics
NPI:1376605410
Name:GALLI, VIVIANA BEATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:BEATRIZ
Last Name:GALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 MONHAGEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6020
Mailing Address - Country:US
Mailing Address - Phone:845-342-8888
Mailing Address - Fax:845-342-8889
Practice Address - Street 1:197 MONHAGEN AVE.
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-342-8888
Practice Address - Fax:845-342-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2351152084P0800X, 2084P0804X, 2084P0804X
PAMD4359572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400139966Medicare PIN
NY03004253Medicaid
NYA400007375Medicare PIN