Healthcare Provider Details

I. General information

NPI: 1982995692
Provider Name (Legal Business Name): SEAN C GALLIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 FOREST AVE
STATEN ISLAND NY
10310-2419
US

IV. Provider business mailing address

96 DACOSTA AVE
OCEANSIDE NY
11572-1001
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-7425
  • Fax:
Mailing address:
  • Phone: 516-351-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number292502
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number292502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: