Provider Demographics
NPI:1750834446
Name:GALLERIA WELLNESS MEDICAL
Entity Type:Organization
Organization Name:GALLERIA WELLNESS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2121-755-5500
Mailing Address - Street 1:115 E 57TH ST STE 520
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2221
Mailing Address - Country:US
Mailing Address - Phone:212-755-5500
Mailing Address - Fax:212-755-0505
Practice Address - Street 1:115 E 57TH ST STE 520
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2221
Practice Address - Country:US
Practice Address - Phone:212-755-5500
Practice Address - Fax:212-755-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2297822081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty