Provider Demographics
NPI:1538138656
Name:GALLICK, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:GALLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2780 MORRIS AVE
Mailing Address - Street 2:STE 2C
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4848
Mailing Address - Country:US
Mailing Address - Phone:908-686-6665
Mailing Address - Fax:908-686-5245
Practice Address - Street 1:2780 MORRIS AVE
Practice Address - Street 2:STE 2C
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4848
Practice Address - Country:US
Practice Address - Phone:908-686-6665
Practice Address - Fax:908-686-5245
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA39446207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54349Medicare UPIN
NJ0455810001Medicare NSC