Provider Demographics
NPI:1699920108
Name:JON B. GALLINATTI DPM,PA
Entity type:Organization
Organization Name:JON B. GALLINATTI DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:GALLINATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,PA
Authorized Official - Phone:305-829-5001
Mailing Address - Street 1:8587 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2500
Mailing Address - Country:US
Mailing Address - Phone:305-829-5001
Mailing Address - Fax:305-829-3902
Practice Address - Street 1:8587 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2500
Practice Address - Country:US
Practice Address - Phone:305-829-5001
Practice Address - Fax:305-829-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty