Provider Demographics
NPI:1700668134
Name:GALLAGHER, MARGUERITE (LAC)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6023
Mailing Address - Country:US
Mailing Address - Phone:516-236-3413
Mailing Address - Fax:
Practice Address - Street 1:180 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7821
Practice Address - Country:US
Practice Address - Phone:516-236-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007397-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist