Provider Demographics
NPI:1568710374
Name:GALLAGHER, PATRICIA ANN
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:GALLAGHER
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 1:570 BROADWAY
Mailing Address - Street 2:APT. 3B
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3945
Mailing Address - Country:US
Mailing Address - Phone:516-521-8108
Mailing Address - Fax:
Practice Address - Street 1:570 BROADWAY
Practice Address - Street 2:APT. 3B
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3945
Practice Address - Country:US
Practice Address - Phone:516-521-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator