Provider Demographics
NPI:1619037686
Name:GALLAGHER, MICHAEL H (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 191
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-747-5050
Mailing Address - Fax:516-747-5929
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 191
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-747-5050
Practice Address - Fax:516-747-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009165-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5497XWTT1Medicare PIN