Healthcare Provider Details

I. General information

NPI: 1881637965
Provider Name (Legal Business Name): EDWARD J GALLAGHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HADDON AVE STE 106
HADDON TOWNSHIP NJ
08108-2810
US

IV. Provider business mailing address

216 HADDON AVE STE 106
HADDON TOWNSHIP NJ
08108-2810
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3879
  • Fax: 856-757-3760
Mailing address:
  • Phone: 856-833-1790
  • Fax: 856-833-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA03779100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: