Healthcare Provider Details

I. General information

NPI: 1972485050
Provider Name (Legal Business Name): ERIC PALACIOS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROADHOLLOW RD STE 201
MELVILLE NY
11747-4833
US

IV. Provider business mailing address

265 BROADHOLLOW RD STE 201
MELVILLE NY
11747-4833
US

V. Phone/Fax

Practice location:
  • Phone: 631-759-4500
  • Fax:
Mailing address:
  • Phone: 631-759-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number805553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: