Provider Demographics
NPI:1295305191
Name:GALLO, JESSICA M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:GALLO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:2 CROSFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2233
Mailing Address - Country:US
Mailing Address - Phone:845-368-0286
Mailing Address - Fax:
Practice Address - Street 1:2 CROSFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2233
Practice Address - Country:US
Practice Address - Phone:845-368-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical