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General NPI Number Information
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NPI Number | 1003080482
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Entity Type | Individual
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Provider Name | PEDRO XAVIER PALACIOS PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 5645 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-5045
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Country | US
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Telephone | 718-670-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 171 E 17TH ST
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-3028
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Country | US
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Telephone | 631-385-2145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 012524
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License Number State | NY
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