Healthcare Provider Details

I. General information

NPI: 1841453669
Provider Name (Legal Business Name): CONO WILLIAM GALLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SUNRISE HWY
LINDENHURST NY
11757-2598
US

IV. Provider business mailing address

150 E SUNRISE HWY
LINDENHURST NY
11757-2598
US

V. Phone/Fax

Practice location:
  • Phone: 631-225-7200
  • Fax: 631-930-9451
Mailing address:
  • Phone: 631-225-7200
  • Fax: 631-930-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number241006
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03125606
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: