Provider Demographics
NPI:1902409196
Name:GALLO, MATTHEW DAMIAN
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAMIAN
Last Name:GALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6216
Mailing Address - Country:US
Mailing Address - Phone:203-944-3718
Mailing Address - Fax:203-929-3068
Practice Address - Street 1:10 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6216
Practice Address - Country:US
Practice Address - Phone:203-944-3718
Practice Address - Fax:203-929-3068
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62036984208100000X
CT10533208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation