MEDICARE: DR. RICHARD GALASSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	38MC00484300	NJ

General Provider Information

NPI Number	:	1528102043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GALASSO

Provider Business Mailing Address
First Line	:	16 WESTON ST
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-2846
Country	:	US
Telephone Number	:	973-667-6864
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 WASHINGTON AVE
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-3934
Country	:	US
Telephone Number	:	973-271-1936
Fax Number	:	973-667-1005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	03/14/2011

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