Provider Demographics
NPI:1700149697
Name:GALEAS, JESSICA LAUREN (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:GALEAS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:687 BRONX RIVER RD
Mailing Address - Street 2:5G
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1719
Mailing Address - Country:US
Mailing Address - Phone:347-749-5116
Mailing Address - Fax:
Practice Address - Street 1:687 BRONX RIVER RD
Practice Address - Street 2:5G
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1719
Practice Address - Country:US
Practice Address - Phone:347-749-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY842831390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program