MEDICARE: WILLIAM GILLIGAN P.T.

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	174400000X	Specialist	40QA00376400	NJ
2	225100000X	Physical Therapist	40QA00376400	NJ

General Provider Information

NPI Number	:	1316940638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM GILLIGAN P.T.

Provider Business Mailing Address
First Line	:	1200 E RIDGEWOOD AVE STE 200
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-327-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E RIDGEWOOD AVE STE 200
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-327-8600
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/29/2025

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Directions to “ WILLIAM GILLIGAN P.T.” Practice Location

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