Provider Demographics
NPI:1629302013
Name:GALLER, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:GALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10786 ASHMONT DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6403
Mailing Address - Country:US
Mailing Address - Phone:561-702-2257
Mailing Address - Fax:561-886-6566
Practice Address - Street 1:300 HYLAN DR
Practice Address - Street 2:# 107
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4216
Practice Address - Country:US
Practice Address - Phone:585-935-7116
Practice Address - Fax:561-886-6566
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147538207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease