Provider Demographics
NPI:1588637748
Name:GALLIGUEZ, LEO E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:E
Last Name:GALLIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 WINSTON CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1406
Mailing Address - Country:US
Mailing Address - Phone:732-341-8384
Mailing Address - Fax:
Practice Address - Street 1:525 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4022
Practice Address - Country:US
Practice Address - Phone:732-920-1551
Practice Address - Fax:732-920-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03004800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4703201Medicaid
NJ110172483OtherRAILROAD MEDICARE
NJP452566OtherOXFORD
NJ223360408-001OtherQUALCARE
NJ1K1006OtherHEALTHNET
NJ427218Medicare ID - Type Unspecified
NJ4703201Medicaid