Healthcare Provider Details

I. General information

NPI: 1093486789
Provider Name (Legal Business Name): JESSICA GALLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

211 RIDGELINE DR
POUGHKEEPSIE NY
12603-6282
US

V. Phone/Fax

Practice location:
  • Phone: 800-636-6683
  • Fax:
Mailing address:
  • Phone: 914-907-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: