Provider Demographics
NPI:1881637965
Name:GALLAGHER, EDWARD J (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:GALLAGHER
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 1:216 HADDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2810
Mailing Address - Country:US
Mailing Address - Phone:856-833-1790
Mailing Address - Fax:856-833-1793
Practice Address - Street 1:216 HADDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2810
Practice Address - Country:US
Practice Address - Phone:856-757-3879
Practice Address - Fax:856-757-3760
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03779100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1081543OtherHORIZON NJ HEALTH
NJ222445694OtherTAX ID
1095619001OtherCIGNA
824095OtherCCN
30017393OtherKEYSTONE MERCY
63810OtherPA BLUE SHIELD
F01765OtherHEALTHNET
NJ0075655000OtherAMERIHEALTH / KEYSTONE
NJ2180103Medicaid
4238146OtherAETNA
NJ250002696OtherRAILROAD MEDICARE
JS181OtherOXFORD
19073OtherMHCS