Provider Demographics
NPI:1316001431
Name:PALUMBO, ROBERT (PH D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 HALF HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5829
Mailing Address - Country:US
Mailing Address - Phone:631-351-1120
Mailing Address - Fax:631-980-3610
Practice Address - Street 1:456 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5829
Practice Address - Country:US
Practice Address - Phone:631-351-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300001748OtherMEDICARE PTAN
NYA300001748Medicare PIN
NYA300001748OtherMEDICARE PTAN