Basic Information
| Provider Information | |||||||||
| NPI: | 1508582040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLO | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 RICKLAND DR | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080803327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563416967 | ||||||||
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| Practice Location | |||||||||
| Address1: | CHILDREN'S HOSPITAL OF PHILADELPHIA DIVISION OF OTOLARY | ||||||||
| Address2: | 3500 CIVIC CENTER BLVD., 5TH FL. | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ01345500 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | SP026331 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.