Provider Demographics
NPI:1770325649
Name:GALESTRO, LISE (NP)
Entity type:Individual
Prefix:MRS
First Name:LISE
Middle Name:
Last Name:GALESTRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:
Other - Last Name:HOYDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6136 170TH ST APT M4
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1957
Mailing Address - Country:US
Mailing Address - Phone:187-090-9407
Mailing Address - Fax:
Practice Address - Street 1:200 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1219
Practice Address - Country:US
Practice Address - Phone:718-448-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311214363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology