Provider Demographics
NPI:1518121052
Name:JASON M GALLINA MD PC
Entity Type:Organization
Organization Name:JASON M GALLINA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-616-4130
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10163-0182
Mailing Address - Country:US
Mailing Address - Phone:212-616-4130
Mailing Address - Fax:212-691-6370
Practice Address - Street 1:820 2ND AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4504
Practice Address - Country:US
Practice Address - Phone:212-616-4130
Practice Address - Fax:212-691-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234845207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty