Provider Demographics
NPI:1013909530
Name:GALLER, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:GALLER
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 1:718 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2331
Mailing Address - Country:US
Mailing Address - Phone:609-927-8550
Mailing Address - Fax:609-926-0273
Practice Address - Street 1:718 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2331
Practice Address - Country:US
Practice Address - Phone:609-927-8550
Practice Address - Fax:609-926-0273
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40170208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3271200Medicaid
NJGA428557Medicare ID - Type Unspecified
NJ3271200Medicaid