Healthcare Provider Details

I. General information

NPI: 1194041046
Provider Name (Legal Business Name): THOMAS PALUMBO RN, NPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PAYSON AVE APT 4F
NEW YORK NY
10034-2775
US

IV. Provider business mailing address

115 PAYSON AVE APT 4F
NEW YORK NY
10034-2775
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-3897
  • Fax:
Mailing address:
  • Phone: 212-304-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number6105794
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: