Provider Demographics
NPI:1255377461
Name:GALLAGHER, ELLEN E (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:E
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:585 NEW LOUDON ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189
Mailing Address - Country:US
Mailing Address - Phone:518-783-1472
Mailing Address - Fax:518-783-1605
Practice Address - Street 1:585 NEW LOUDON ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-783-1472
Practice Address - Fax:518-783-1605
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420421363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health