Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 401315 | NY |
NPI | 1023321692 |
---|---|
Provider Name | Mrs. Suzanne Gallagher |
First Address | New Canaan, CT 06840-6513 |
Second Address | New York, NY 10003-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2010 |
Last Update Date | 23/07/2010 |