1881637965 NPI number — EDWARD J GALLAGHER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881637965 NPI number — EDWARD J GALLAGHER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GALLAGHER

Provider First Name:

EDWARD

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1881637965

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

216 HADDON AVE STE 106

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HADDON TOWNSHIP

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08108-2810

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-833-1790

Provider Business Mailing Address Fax Number:

856-833-1793

Provider First Line Business Practice Location Address:

216 HADDON AVE STE 106

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HADDON TOWNSHIP

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08108-2810

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-757-3879

Provider Business Practice Location Address Fax Number:

856-757-3760

Provider Enumeration Date:

06/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208100000X , with the licence number:  25MA03779100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1081543 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 222445694 . This is a "TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1095619001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 824095 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
• Identifier: 30017393 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
• Identifier: 63810 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: F01765 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 0075655000 . This is a "AMERIHEALTH / KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2180103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 4238146 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 250002696 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: JS181 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 19073 . This is a "MHCS" identifier . This identifiers is of the category "OTHER".