Provider Demographics
NPI:1730586520
Name:GALLEGOS, BIELKA
Entity type:Individual
Prefix:
First Name:BIELKA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1319
Mailing Address - Country:US
Mailing Address - Phone:646-232-7616
Mailing Address - Fax:
Practice Address - Street 1:120 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1319
Practice Address - Country:US
Practice Address - Phone:646-232-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist