Provider Demographics
NPI:1205032224
Name:PALANCE, ADAM L (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:PALANCE
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 1:1086 TEANECK RD
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:201-837-9449
Mailing Address - Fax:201-578-1699
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:SUITE 4C
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-837-9449
Practice Address - Fax:201-578-1290
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07621500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist