Provider Demographics
NPI:1942226634
Name:PALUMBO, SHELLEY (DPT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WASHINGTON ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4908
Mailing Address - Country:US
Mailing Address - Phone:201-484-0134
Mailing Address - Fax:201-484-7123
Practice Address - Street 1:608 WASHINGTON ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4908
Practice Address - Country:US
Practice Address - Phone:201-484-0134
Practice Address - Fax:201-484-7123
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA08752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095743Medicare ID - Type UnspecifiedMEDICARE ID NO.
NJ089294Medicare ID - Type UnspecifiedPHYSICIAN IDENTIFICATION