Provider Demographics
NPI:1356064190
Name:CLAYBROOKS, GALEN GERMAINE
Entity type:Individual
Prefix:MR
First Name:GALEN
Middle Name:GERMAINE
Last Name:CLAYBROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6253
Mailing Address - Country:US
Mailing Address - Phone:856-405-9908
Mailing Address - Fax:
Practice Address - Street 1:1419 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6253
Practice Address - Country:US
Practice Address - Phone:856-405-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor