Healthcare Provider Details

I. General information

NPI: 1891855946
Provider Name (Legal Business Name): CHRISTOPHER PALESTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIJMC DEPT OF MEDICINE DIVISION OF NUCLEAR MEDICINE 270 05 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

LIJMC DEPT OF MEDICINE DIVISION OF NUCLEAR MEDICINE LIJMC DEPT OF MEDICINE DIVISION OF NUCLEAR MEDICINE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7081
  • Fax:
Mailing address:
  • Phone: 718-470-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number132382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: