Provider Demographics
NPI:1861652752
Name:GALLAGHER, EILEEN M (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W CARVER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-0688
Practice Address - Street 1:200 W CARVER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3303
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:631-421-0688
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681410Medicaid
762921Medicare PIN
NYG29167Medicare UPIN