MEDICARE: ESTELLE GALLO PT

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	174400000X	Specialist	62023672	NY

General Provider Information

NPI Number	:	1932328283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELLE GALLO PT

Provider Business Mailing Address
First Line	:	195 WILLOUGHBY AVE
Second Line	:	APT 1401
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 WILLOUGHBY AVE
Second Line	:	APT 1401
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3843
Country	:	US
Telephone Number	:	917-903-4659
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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