Provider Demographics
NPI:1689695918
Name:PRADO-GALARZA, NEIZA L (MD)
Entity Type:Individual
Prefix:
First Name:NEIZA
Middle Name:L
Last Name:PRADO-GALARZA
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:PO BOX 7047
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7047
Mailing Address - Country:US
Mailing Address - Phone:732-431-8075
Mailing Address - Fax:732-431-0307
Practice Address - Street 1:200 VILLAGE CENTER DR
Practice Address - Street 2:SUITE #7047
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3197
Practice Address - Country:US
Practice Address - Phone:732-431-8075
Practice Address - Fax:732-431-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063150002084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6887406Medicaid
NJMEDICAIN PROVIDER #Medicaid
NJ6887406Medicaid
NJMEDICAIN PROVIDER #Medicaid
NJMEDICARE UPIN #Medicare UPIN