Individual ProviderMichael GannonFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1973 Washington Valley Rd, Martinsville, NJ 08836-2053(732) 560-9225(844) 362-1735PECOS EnrollmentBased on the most recent information from CMS, provider Michael Gannon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1225441215Provider TypeIndividualFull NameGannon, MichaelTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date6/6/2014Last Updated9/7/2023Contact InformationPractice LocationPractice Address1973 Washington Valley Rd, Martinsville, NJ 08836-2053Phone(732) 560-9225Fax(732) 560-8095Mailing LocationMailing AddressPO Box 416457, Boston, MA 02241-2053Phone(844) 362-1735Fax(973) 290-7495Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense25MA09511000New Jersey