Provider Demographics
NPI:1396877114
Name:GALLAGHER, ROBERT G (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4633
Mailing Address - Country:US
Mailing Address - Phone:516-538-2372
Mailing Address - Fax:516-538-2372
Practice Address - Street 1:1563 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4633
Practice Address - Country:US
Practice Address - Phone:516-538-2372
Practice Address - Fax:516-538-2372
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX0H641Medicare ID - Type Unspecified