Provider Demographics
NPI:1821212648
Name:GALLAGHER, E JOHN (MD)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:JOHN
Last Name:GALLAGHER
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 1:3755 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 14G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1535
Mailing Address - Country:US
Mailing Address - Phone:718-920-6626
Mailing Address - Fax:718-798-0730
Practice Address - Street 1:MMC - EMERGENCY MEDICINE
Practice Address - Street 2:1825 EASTCHESTER ROAD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120041207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine