Provider Demographics
NPI:1790086635
Name:ROBERT JAMES GALLO, M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT JAMES GALLO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-6633
Mailing Address - Street 1:125 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2233
Mailing Address - Country:US
Mailing Address - Phone:201-342-6633
Mailing Address - Fax:201-342-3570
Practice Address - Street 1:125 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2233
Practice Address - Country:US
Practice Address - Phone:201-342-6633
Practice Address - Fax:201-342-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03553400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63127Medicare UPIN