Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA09786900 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA09786900 | NJ |
NPI | 1295170082 |
---|---|
Provider Name | William Joseph Gallagher |
First Address | Brick, NJ 08724-7776 |
Second Address | Brick, NJ 08724-7776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 31/01/2021 |