Healthcare Provider Details

I. General information

NPI: 1891173241
Provider Name (Legal Business Name): JEANNE GALLO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

IV. Provider business mailing address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-2000
  • Fax:
Mailing address:
  • Phone: 718-226-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407691-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: