Healthcare Provider Details

I. General information

NPI: 1043767155
Provider Name (Legal Business Name): RADICA PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 E MAIN ST
HUNTINGTON NY
11743-2917
US

IV. Provider business mailing address

2186 BABYLON TPKE
MERRICK NY
11566-3518
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-9787
  • Fax:
Mailing address:
  • Phone: 516-378-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307868-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: