1942278486 NPI number — MS. JULIE MAUREEN GALLAGHER P.T.

Table of content: MS. JULIE MAUREEN GALLAGHER P.T. (NPI 1942278486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942278486 NPI number — MS. JULIE MAUREEN GALLAGHER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
JULIE
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1942278486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 W SIENKO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALLSTEAD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18822-9784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-879-1084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16749 STATE ROUTE 706
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18801-7706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-1101
Provider Business Practice Location Address Fax Number:
570-278-1102
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  026910-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT012734L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 825514 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2143769 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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