Provider Demographics
NPI:1356467229
Name:GALLINA, JASON MARC (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MARC
Last Name:GALLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 182
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10163-0182
Mailing Address - Country:US
Mailing Address - Phone:212-616-4130
Mailing Address - Fax:212-691-6370
Practice Address - Street 1:820 SECOND AVENUE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1007
Practice Address - Country:US
Practice Address - Phone:212-616-4130
Practice Address - Fax:212-691-6370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234845207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234845OtherLICENSE NUMBER