Provider Demographics
NPI:1265072227
Name:GALLO, MICHAEL JR (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GALLO
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2219
Mailing Address - Country:US
Mailing Address - Phone:315-413-1812
Mailing Address - Fax:
Practice Address - Street 1:555 S STATE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2280
Practice Address - Country:US
Practice Address - Phone:315-413-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily