Provider Demographics
NPI:1720149743
Name:BARRY J. GALLANTER, DPM PA
Entity type:Organization
Organization Name:BARRY J. GALLANTER, DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GALLANTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-823-2778
Mailing Address - Street 1:138 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-9200
Mailing Address - Country:US
Mailing Address - Phone:201-823-2778
Mailing Address - Fax:201-823-1019
Practice Address - Street 1:138 W 56TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-9200
Practice Address - Country:US
Practice Address - Phone:201-823-2778
Practice Address - Fax:201-823-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00128200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3148904Medicaid
NJ610657Medicare ID - Type UnspecifiedGROUP PROVIDER #
NJ0673120001Medicare NSC
NJ3148904Medicaid