MEDICARE: GREGORY S GALLICK MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	MA39446	NJ

General Provider Information

NPI Number	:	1538138656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S GALLICK MD

Provider Business Mailing Address
First Line	:	2780 MORRIS AVE
Second Line	:	STE 2C
City	:	UNION
State	:	NJ
Zip	:	07083-4848
Country	:	US
Telephone Number	:	908-686-6665
Fax Number	:	908-686-5245

Provider Business Practice Location Address
First Line	:	2780 MORRIS AVE
Second Line	:	STE 2C
City	:	UNION
State	:	NJ
Zip	:	07083-4848
Country	:	US
Telephone Number	:	908-686-6665
Fax Number	:	908-686-5245

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/24/2008

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