Provider Demographics
NPI:1588190912
Name:GALLO, PATRICIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SATELLITE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752
Mailing Address - Country:US
Mailing Address - Phone:631-219-5369
Mailing Address - Fax:
Practice Address - Street 1:16 SATELLITE DRIVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752
Practice Address - Country:US
Practice Address - Phone:631-219-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist