Provider Demographics
NPI:1639107451
Name:GALLER, ROBERT (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GALLER
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 COUNTY ROAD 111
Mailing Address - Street 2:BUILDING D
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-405-3245
Mailing Address - Fax:631-281-1420
Practice Address - Street 1:496 COUNTY ROAD 111
Practice Address - Street 2:BUILDING D
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949
Practice Address - Country:US
Practice Address - Phone:631-405-3245
Practice Address - Fax:631-281-1420
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208682207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6X8981OtherEMPIRE BC.BS
NY7247422OtherAETNA
NY02396936Medicaid
NY6X8981OtherEMPIRE BC.BS
NY02396936Medicaid