Provider Demographics
NPI:1912008855
Name:GALIBOV, RAYA (PA)
Entity Type:Individual
Prefix:MS
First Name:RAYA
Middle Name:
Last Name:GALIBOV
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CENTRAL PARK W
Mailing Address - Street 2:OFC 14
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4198
Mailing Address - Country:US
Mailing Address - Phone:212-877-2100
Mailing Address - Fax:212-873-9311
Practice Address - Street 1:115 CENTRAL PARK W
Practice Address - Street 2:OFC 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4198
Practice Address - Country:US
Practice Address - Phone:212-877-2100
Practice Address - Fax:212-873-9311
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00330231Medicare ID - Type Unspecified
NY00246075Medicaid