Provider Demographics
NPI:1972731453
Name:GOLDEN GATE PKWY PAIN & INJURY REHAB., INC.
Entity type:Organization
Organization Name:GOLDEN GATE PKWY PAIN & INJURY REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GADALETA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-304-9166
Mailing Address - Street 1:5425 GOLDEN GATE PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7524
Mailing Address - Country:US
Mailing Address - Phone:239-304-9166
Mailing Address - Fax:239-304-9170
Practice Address - Street 1:5425 GOLDEN GATE PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7524
Practice Address - Country:US
Practice Address - Phone:239-304-9166
Practice Address - Fax:239-304-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6792261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center