Provider Demographics
NPI:1114328986
Name:MULLIGAN, GARY JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1541
Mailing Address - Country:US
Mailing Address - Phone:917-432-4273
Mailing Address - Fax:
Practice Address - Street 1:226 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1945
Practice Address - Country:US
Practice Address - Phone:732-888-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01569700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist