Healthcare Provider Details

I. General information

NPI: 1609071737
Provider Name (Legal Business Name): JOHN HUGH GALLAGHER M.S., P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAIN ST
HACKENSACK NJ
07601-5914
US

IV. Provider business mailing address

6 TERRY CT
MONTVALE NJ
07645-2149
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0488
  • Fax:
Mailing address:
  • Phone: 201-391-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number022787-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01307100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: