Provider Demographics
NPI:1669420519
Name:ZABEK-GALLEGOS, JOANNA (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ZABEK-GALLEGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ACKERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4203
Mailing Address - Country:US
Mailing Address - Phone:201-444-3309
Mailing Address - Fax:
Practice Address - Street 1:265 ACKERMAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4203
Practice Address - Country:US
Practice Address - Phone:201-444-3309
Practice Address - Fax:201-444-3349
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06705000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0918458Medicaid
NJ7608501Medicaid
NJ8924503Medicaid