Provider Demographics
NPI:1255694923
Name:PALOMO, SAMUEL CALIS (SPEDTEACHER)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:CALIS
Last Name:PALOMO
Suffix:
Gender:M
Credentials:SPEDTEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FORDHAM HILL OVAL APT 2D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4710
Mailing Address - Country:US
Mailing Address - Phone:646-270-9140
Mailing Address - Fax:
Practice Address - Street 1:3 FORDHAM HILL OVAL APT.2D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:646-270-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1633876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist