Provider Demographics
NPI:1669468740
Name:PALACE, ZACHARY JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:JULIAN
Last Name:PALACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:WESLEY HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1301
Mailing Address - Country:US
Mailing Address - Phone:718-581-1495
Mailing Address - Fax:718-581-1012
Practice Address - Street 1:5901 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1205
Practice Address - Country:US
Practice Address - Phone:718-581-1495
Practice Address - Fax:718-581-1012
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY208688207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11135Medicare UPIN
NY56C761Medicare PIN