1235250838 NPI number — MR. DENNIS P. GALLO PHD, CLINICAL PSYCHO

Table of content: PATRICIA BAKER WADSWORTH (NPI 1013558121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235250838 NPI number — MR. DENNIS P. GALLO PHD, CLINICAL PSYCHO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLO
Provider First Name:
DENNIS
Provider Middle Name:
P.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, CLINICAL PSYCHO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235250838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 HARRIET ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11703-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-422-2962
Provider Business Mailing Address Fax Number:
631-422-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 HARRIET ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11703-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-422-2962
Provider Business Practice Location Address Fax Number:
631-422-2962
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  004691 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008966399 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: DR7076 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: V5529 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004389686 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A058227 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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