Provider Demographics
NPI:1467542365
Name:GALVAO, MARIE (ANP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GALVAO
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11A RIVER LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1926
Mailing Address - Country:US
Mailing Address - Phone:718-920-2248
Mailing Address - Fax:718-231-6257
Practice Address - Street 1:MMC - DEPT. OF CARDIOLOGY
Practice Address - Street 2:3400 BAINBRIDGE AVE., 7TH FLR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2248
Practice Address - Fax:718-652-1833
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02655796Medicaid
NY02655796Medicaid
NY007082Medicare ID - Type Unspecified