Provider Demographics
NPI:1902221104
Name:GALLAGHER, DANIEL PATRICK
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PATRICK
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 1:18 VEE JAY DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2243
Mailing Address - Country:US
Mailing Address - Phone:631-885-3079
Mailing Address - Fax:
Practice Address - Street 1:18 VEE JAY DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-2243
Practice Address - Country:US
Practice Address - Phone:631-885-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541205041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist