Provider Demographics
NPI:1114005329
Name:PALMIERY, PONCIANO P (MD)
Entity Type:Individual
Prefix:DR
First Name:PONCIANO
Middle Name:P
Last Name:PALMIERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1775
Mailing Address - Country:US
Mailing Address - Phone:973-484-2584
Mailing Address - Fax:973-484-9216
Practice Address - Street 1:332 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1775
Practice Address - Country:US
Practice Address - Phone:973-484-2584
Practice Address - Fax:973-484-9216
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03479100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1793306Medicaid