Provider Demographics
NPI:1841233418
Name:PALUMBO, ADRIANA (OD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOOVER PL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2607
Mailing Address - Country:US
Mailing Address - Phone:973-467-1810
Mailing Address - Fax:973-467-4225
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:973-467-1810
Practice Address - Fax:973-467-4225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00565603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ009506Medicare ID - Type Unspecified
NJU99774Medicare UPIN