Provider Demographics
NPI:1386613362
Name:GALLO, MICHAEL V (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:GALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2922
Mailing Address - Country:US
Mailing Address - Phone:516-248-7733
Mailing Address - Fax:513-248-5031
Practice Address - Street 1:1075 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2922
Practice Address - Country:US
Practice Address - Phone:516-248-7733
Practice Address - Fax:513-248-5031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231687208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46182Medicare UPIN
7012F1Medicare ID - Type Unspecified