=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134665649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN P. PALUMBO PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2017
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 ENGLISH CREEK AVE STE 1300
-----------------------------------------------------
City | EGG HARBOR TWP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08234-5598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-321-9999
-----------------------------------------------------
Fax | 267-479-1321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 CHESTNUT ST STE 520
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-4430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-321-9999
-----------------------------------------------------
Fax | 267-479-1321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA059711
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 25MP00556200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------