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General NPI Number Information
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NPI Number | 1710064639
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Entity Type | Individual
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Provider Name | GARY V PALUBA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 1025 NORTHERN BLVD SUITE 100
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City | ROSLYN
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State | NY
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Zip | 11576-1506
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Country | US
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Telephone | 516-365-7458
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Fax |
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Provider Business Mailing Address
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Address Line | 145 E 92ND ST 6A
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City | NEW YORK
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State | NY
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Zip | 10128-2431
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Country | US
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Telephone | 212-876-4936
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6382
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License Number State | NY
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