Provider Demographics
NPI:1194041046
Name:PALUMBO, THOMAS (RN, NPP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:RN, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PAYSON AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2775
Mailing Address - Country:US
Mailing Address - Phone:212-304-3897
Mailing Address - Fax:
Practice Address - Street 1:115 PAYSON AVE APT 4F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2775
Practice Address - Country:US
Practice Address - Phone:212-304-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6105794163WP0809X
NYF401221363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult