Individual
DR. CARLOS GALLEGOS RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
9 MEMORIAL PKWY, LONG BRANCH, NJ 07740-6701
(732) 728-7010
(732) 728-0704
Mailing address
26 DAKARLA DR, MIDDLETOWN, NJ 07748-3171
(732) 957-0408
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
25MA06184200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223601506
TAX ID
NJ
01
—
31D0941981
CLIA NUMBER
NJ
05
—
6635008
—
NJ
Enumeration date
06/22/2006
Last updated
02/08/2013
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