Healthcare Provider Details

I. General information

NPI: 1386815611
Provider Name (Legal Business Name): NICHOLAS PALAMIDESSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF EMERGENCY MEDICINE STONY HSC L4, RM 080
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

45 WALL ST APT 617
NEW YORK NY
10005-1918
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax:
Mailing address:
  • Phone: 917-992-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number248032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: