Provider Demographics
NPI:1760490106
Name:ELEFANT GALANTE PC
Entity Type:Organization
Organization Name:ELEFANT GALANTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-673-7070
Mailing Address - Street 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-673-7070
Mailing Address - Fax:215-673-2828
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-673-7070
Practice Address - Fax:215-673-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006402320003Medicaid
0054112001OtherIBC
084684Medicare ID - Type Unspecified