Provider Demographics
NPI:1598055824
Name:GREGORY J GALLINA MD PC
Entity Type:Organization
Organization Name:GREGORY J GALLINA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-525-1031
Mailing Address - Street 1:255 WEST SPRING VALLEY AVE.
Mailing Address - Street 2:# 103
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1444
Mailing Address - Country:US
Mailing Address - Phone:201-525-1031
Mailing Address - Fax:201-880-4560
Practice Address - Street 1:255 WEST SPRING VALLEY AVE.
Practice Address - Street 2:# 103
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:201-525-1031
Practice Address - Fax:201-880-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62495208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024455Medicare UPIN