MEDICARE: CLAIRE GILGANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	004848-1	NY

General Provider Information

NPI Number	:	1164738241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE GILGANNON

Provider Business Mailing Address
First Line	:	444 E 75TH ST
Second Line	:	APT 4C
City	:	NEW YORK
State	:	NY
Zip	:	10021-3456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 E 75TH ST
Second Line	:	APT 4C
City	:	NEW YORK
State	:	NY
Zip	:	10021-3456
Country	:	US
Telephone Number	:	212-396-2896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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Directions to “ CLAIRE GILGANNON ” Practice Location

Language	Start Address	Practice Location

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