Provider Demographics
NPI:1619483211
Name:JAMES W GALASSO III D.O.
Entity Type:Organization
Organization Name:JAMES W GALASSO III D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GALASSO
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:570-283-3301
Mailing Address - Street 1:1169 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4003
Mailing Address - Country:US
Mailing Address - Phone:570-283-3301
Mailing Address - Fax:570-283-3304
Practice Address - Street 1:1169 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4003
Practice Address - Country:US
Practice Address - Phone:570-283-3301
Practice Address - Fax:570-283-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007884L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty