Provider Demographics
NPI:1790418531
Name:GALLOY, MARY (AUD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GALLOY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD. - ENTA
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-6802
Mailing Address - Country:US
Mailing Address - Phone:914-984-2552
Mailing Address - Fax:718-208-4663
Practice Address - Street 1:300 CADMAN PLZ W STE 1301
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3229
Practice Address - Country:US
Practice Address - Phone:718-208-4449
Practice Address - Fax:718-208-4663
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003094231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist