Provider Demographics
NPI:1629892294
Name:GALLAGHER, JOHN THOMAS (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 EAGLES NEST LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1233
Mailing Address - Country:US
Mailing Address - Phone:718-308-6126
Mailing Address - Fax:
Practice Address - Street 1:15 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1028
Practice Address - Country:US
Practice Address - Phone:718-308-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352432-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily