MEDICARE: ASHLEE MARIE GALLO MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	885986142	NY

General Provider Information

NPI Number	:	1295424703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE MARIE GALLO MS

Provider Business Mailing Address
First Line	:	179 REGIS DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1423
Country	:	US
Telephone Number	:	646-427-0608
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 REGIS DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1423
Country	:	US
Telephone Number	:	646-427-0608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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