1104928118 NPI number — CECILIA LIWAG GALLAGHER PT

Table of content: CECILIA LIWAG GALLAGHER PT (NPI 1104928118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104928118 NPI number — CECILIA LIWAG GALLAGHER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
CECILIA
Provider Middle Name:
LIWAG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIWAG
Provider Other First Name:
CECILIA
Provider Other Middle Name:
PINEDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104928118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 CEDAR ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS-ON-HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-478-3983
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 WEST 43RD ST.
Provider Second Line Business Practice Location Address:
#405
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-245-7278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

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:  009814 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5405293 . This is a "CIGNA PPO PAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7603604 . This is a "AETNA NON-PAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12068039 . This is a "MULTIPLAN PAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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