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NPI Code Detail

MEDICARE: MARIA GALLUP

MEDICARE: MARIA GALLUP
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
1164W00000XLicensed Practical Nurse267722NY

General Provider Information

NPI Number : 1649134883
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA GALLUP
Provider Business Mailing Address
First Line : 379 VILLAGE BLVD N
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-3068
Country : US
Telephone Number : 315-476-0600
Fax Number :
Provider Business Practice Location Address
First Line : 1011 W GENESEE ST STE 3
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2329
Country : US
Telephone Number : 315-476-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ MARIA GALLUP ” Practice Location

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