MEDICARE: MARY CAMILLE PALISOC-SALAZAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	326099	NY

General Provider Information

NPI Number	:	1144859125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CAMILLE PALISOC-SALAZAR MD

Provider Business Mailing Address
First Line	:	3333 NEW HYDE PARK RD STE 104
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1205
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 NEW HYDE PARK RD STE 104
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1205
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	08/05/2025

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