Provider Demographics
NPI:1972879492
Name:PALUMBO, STEPHEN (REGISTERD NURSE)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:REGISTERD NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547-77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3307
Mailing Address - Country:US
Mailing Address - Phone:718-710-1829
Mailing Address - Fax:347-396-4767
Practice Address - Street 1:42-09 28TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11101-4132
Practice Address - Country:US
Practice Address - Phone:718-710-1829
Practice Address - Fax:347-396-4767
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487518163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse