Provider Demographics
NPI:1699836692
Name:GALLAGHER, MADELINE M (LPN)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8228
Mailing Address - Country:US
Mailing Address - Phone:845-226-8022
Mailing Address - Fax:
Practice Address - Street 1:2 RIDGEMONT DRIVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT.
Practice Address - State:NY
Practice Address - Zip Code:12533-8228
Practice Address - Country:US
Practice Address - Phone:845-226-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0789491164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450206OtherPRACTICAL NURSE