Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 123512 | NY |
NPI | 1104874536 |
---|---|
Provider Name | Mr. Lawrence Jay Galinkin |
First Address | Old Bethpage, NY 11804-1240 |
Second Address | Old Bethpage, NY 11804-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |