Healthcare Provider Details

I. General information

NPI: 1245330885
Provider Name (Legal Business Name): JESSICA B GALLINA MD PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CENTRAL PARK SO STE 2-0
NEW YORK NY
10019
US

IV. Provider business mailing address

240 CENTRAL PARK SO STE 2-0
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-0255
  • Fax: 212-265-0233
Mailing address:
  • Phone: 212-265-0255
  • Fax: 212-265-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number215872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: