Provider Demographics
NPI:1821472911
Name:GALLAGHER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 N NEWBRIDGE RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1587
Mailing Address - Country:US
Mailing Address - Phone:516-652-0332
Mailing Address - Fax:
Practice Address - Street 1:267 N NEWBRIDGE RD APT 1A
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1587
Practice Address - Country:US
Practice Address - Phone:516-652-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency