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General NPI Number Information
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NPI Number | 1184107005
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Entity Type | Individual
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Provider Name | REBECCA LYNN GALLO PA
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 622 W 168TH ST STE 260
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-305-2995
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CHERRY PL
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-1601
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Country | US
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Telephone | 971-506-4973
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 022499-1
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License Number State | NY
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