MEDICARE: DR. WEINER & DR. GALLO MEDICAL PRACTICE PLLC

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	207Q00000X	Family Medicine Physician	215715	NY

General Provider Information

NPI Number	:	1770758922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. WEINER & DR. GALLO MEDICAL PRACTICE PLLC

Provider Business Mailing Address
First Line	:	2352 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5515
Country	:	US
Telephone Number	:	718-251-0200
Fax Number	:	718-209-5697

Provider Business Practice Location Address
First Line	:	2352 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5515
Country	:	US
Telephone Number	:	718-251-0200
Fax Number	:	718-209-5697

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAWN M GALLO
Credential	:	D.O.
Telephone Number	:	718-251-0200

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	12/18/2008

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