Provider Demographics
NPI:1942048996
Name:GALLANTER, JENNIFER ANN
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:GALLANTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N BAYLES AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2931
Mailing Address - Country:US
Mailing Address - Phone:516-589-4471
Mailing Address - Fax:
Practice Address - Street 1:9045 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7823
Practice Address - Country:US
Practice Address - Phone:718-849-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool