Healthcare Provider Details

I. General information

NPI: 1265607279
Provider Name (Legal Business Name): SOPHIA NATALIE PALMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 ROCHAMBEAU AVE.
BRONX NY
10467
US

IV. Provider business mailing address

3455 BERTHA DR
BALDWIN NY
11510-5029
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6311
  • Fax:
Mailing address:
  • Phone: 917-645-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number248119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: