Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 234845 | NY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 234845 | NY |
NPI | 1356467229 |
---|---|
Provider Name | Jason Marc Gallina |
First Address | New York, NY 10163-0182 |
Second Address | New York, NY 10017-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 23/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
234845 | LICENSE NUMBER (01) | NY |