Provider Demographics
NPI:1629567094
Name:GALFANO, MARIA LORETTA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LORETTA
Last Name:GALFANO
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 1:2 ADRIENNE CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2732
Mailing Address - Country:US
Mailing Address - Phone:631-655-3664
Mailing Address - Fax:
Practice Address - Street 1:2 ADRIENNE CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2732
Practice Address - Country:US
Practice Address - Phone:631-655-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1168261171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist