Provider Demographics
NPI:1114921079
Name:PALLY, STEVEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:PALLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10 JAMES ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1405
Mailing Address - Country:US
Mailing Address - Phone:973-822-0770
Mailing Address - Fax:973-822-2062
Practice Address - Street 1:10 JAMES ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1405
Practice Address - Country:US
Practice Address - Phone:973-822-0770
Practice Address - Fax:973-822-2062
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB55173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5313902Medicaid
NJ5313902Medicaid
702464R97Medicare PIN