Provider Demographics
NPI:1164502696
Name:GALASSO, JENNIFER HOSP (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOSP
Last Name:GALASSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:HOSP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 WEST SPROUL ROAD
Mailing Address - Street 2:HEALTHPLEX SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064
Mailing Address - Country:US
Mailing Address - Phone:610-604-0888
Mailing Address - Fax:610-604-0880
Practice Address - Street 1:196 WEST SPROUL ROAD
Practice Address - Street 2:HEALTHPLEX SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064
Practice Address - Country:US
Practice Address - Phone:610-604-0888
Practice Address - Fax:610-604-0880
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085733Medicaid
PA085733Medicaid