Provider Demographics
NPI:1053384453
Name:GARELL, PAUL C (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:GARELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P.
Other - Middle Name:CHARLES
Other - Last Name:GARELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:670 STONELEIGH AVE
Mailing Address - Street 2:DEPT. OF NEUROSURGERY
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3997
Mailing Address - Country:US
Mailing Address - Phone:845-278-5687
Mailing Address - Fax:866-981-5080
Practice Address - Street 1:670 STONELEIGH AVE
Practice Address - Street 2:DEPT. OF NEUROSURGERY
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3997
Practice Address - Country:US
Practice Address - Phone:845-278-5687
Practice Address - Fax:845-704-2667
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239955207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02820928Medicaid
NY02820928Medicaid
NY3M247X0531Medicare PIN