Healthcare Provider Details

I. General information

NPI: 1376303933
Provider Name (Legal Business Name): VINCENT GALLUB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TENTH AVE 3RD FLOOR, ROOM 3A-08
NEW YORK NY
10019
US

IV. Provider business mailing address

1000 TENTH AVE 3RD FLOOR, ROOM 3A-08
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax:
Mailing address:
  • Phone: 212-259-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: