Provider Demographics
NPI:1285840918
Name:PALERMO, KIM MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:PALERMO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:KUCZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:525 ROUTE 73 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9642
Mailing Address - Country:US
Mailing Address - Phone:856-596-3434
Mailing Address - Fax:856-596-9110
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:SUITE 102
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:856-596-3434
Practice Address - Fax:856-596-9110
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08916600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE167510YYWMedicare PIN
NJG00186Medicare UPIN