1598164816 NPI number — NEELAM KISHOR GALA PA-C

Table of content: NEELAM KISHOR GALA PA-C (NPI 1598164816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598164816 NPI number — NEELAM KISHOR GALA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALA
Provider First Name:
NEELAM
Provider Middle Name:
KISHOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598164816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6950 E BELLEVIEW AVE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-789-5242
Provider Business Mailing Address Fax Number:
303-789-5264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
799 E HAMPDEN AVE STE 315
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-789-5242
Provider Business Practice Location Address Fax Number:
303-789-5264
Provider Enumeration Date:
08/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  0003927 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 58326740 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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