Provider Demographics
NPI:1033278312
Name:GALLANTER, BARRY JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:GALLANTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-9200
Mailing Address - Country:US
Mailing Address - Phone:201-823-2778
Mailing Address - Fax:201-823-1019
Practice Address - Street 1:138 W 56TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-9200
Practice Address - Country:US
Practice Address - Phone:201-823-2778
Practice Address - Fax:201-823-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00128200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1337106Medicaid
NJ1337106Medicaid
NJGA400997Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
NJ0673120001Medicare NSC