Provider Demographics
NPI:1558696864
Name:GALLAGHER, VANESSA J (LAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3015
Mailing Address - Country:US
Mailing Address - Phone:197-608-8716
Mailing Address - Fax:
Practice Address - Street 1:340 ROUTE 202
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3237
Practice Address - Country:US
Practice Address - Phone:917-608-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003960-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist