Jacob Ryan Gallagher, D.O.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

69540 Issued in CT

Practice address

80 Mill River Street
Suite 2400-C
Stamford, CT 06902

Phone

(203) 585-9580

NPI assigned

Apr 26, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 12, 2024 through Jun 12, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1902394752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MILL RIVER STREET",
            "address_2": "SUITE 2400-C",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "06902",
            "telephone_number": "203-585-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MILL RIVER STREET",
            "address_2": "SUITE 2400-C",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "06902",
            "telephone_number": "203-585-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "JACOB",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-26",
        "last_updated": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CT",
            "license": "69540",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John H Gagnon, PHD
• Monique Francine Gagnon, M.D.
• Elizabeth Gaines-Cardone, M.D.
• Csaba Gajdos, MD
• Bobby Gajendran, DDS
• Amy Gallo, LCSW
• Robert J Gallois, DMD
• Vernetta D Gallop, MD
• Gregory M. Gallousis, MD
• Joseph M Gambino, DC

• Neuromusculoskeletal Medicine & OMM Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.