Healthcare Provider Details

I. General information

NPI: 1760552962
Provider Name (Legal Business Name): ROBERT E GALLAGHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF ONCOLOGY 111 EAST 210TH STREET
BRONX NY
10467
US

IV. Provider business mailing address

131 RIVERSIDE DR APT. 8D
NEW YORK NY
10024-3713
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4057
  • Fax:
Mailing address:
  • Phone: 718-920-4057
  • Fax: 718-798-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number162352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: