Healthcare Provider Details

I. General information

NPI: 1164460366
Provider Name (Legal Business Name): VICTORIA RITA PALMER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 MILFORD WARREN GLEN RD
BLOOMSBURY NJ
08804-2023
US

IV. Provider business mailing address

1052 MILFORD WARREN GLEN RD
BLOOMSBURY NJ
08804-2023
US

V. Phone/Fax

Practice location:
  • Phone: 908-995-1590
  • Fax: 908-995-7951
Mailing address:
  • Phone: 908-995-1590
  • Fax: 908-995-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62734
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: