Provider Demographics
NPI:1588700314
Name:GALLAGHER, CAROLYN (RD)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BONNETT AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3204
Mailing Address - Country:US
Mailing Address - Phone:914-834-0244
Mailing Address - Fax:
Practice Address - Street 1:23 BONNETT AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3204
Practice Address - Country:US
Practice Address - Phone:914-834-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8099759OtherGHI
NYVC5800OtherATLANTIS
NY9513E1OtherEMPIRE BLUE CROSS
NY005800OtherHIP
NYP3561724OtherOXFORD
NY2511948OtherUNITED
NY3800088OtherAETNA
NY41942230002OtherCIGNA
NY7606635OtherAETNA