Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 246979 | NY |
NPI | 1104090232 |
---|---|
Provider Name | Dr. David Jason Gallagher |
First Address | Johnson City, NY 13790-2580 |
Second Address | Binghamton, NY 13903-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 23/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03355662 | (05) | NY |