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General NPI Number Information
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NPI Number | 1013012988
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Entity Type | Individual
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Provider Name | JOHN PALMER
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 223 N VAN DIEN AVE THE VALLEY HOSPITAL HEALTH AND FITNESS CENTER
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2726
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Country | US
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Telephone | 201-447-8133
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Fax |
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Provider Business Mailing Address
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Address Line | 31 OVERLOOK DR
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City | NEWBURGH
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State | NY
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Zip | 12550-1332
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00103300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000177-1
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License Number State | NY
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