Provider Demographics
NPI:1821242538
Name:PALUMBO, KATHLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:PALUMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:40 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2036
Mailing Address - Country:US
Mailing Address - Phone:516-293-9631
Mailing Address - Fax:
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-293-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679529163W00000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821242538Medicaid