Provider Demographics
NPI:1295888923
Name:PALLONE, JENNIFER A (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:PALLONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 86TH AVE STE Z
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6236
Mailing Address - Country:US
Mailing Address - Phone:219-769-0777
Mailing Address - Fax:219-755-0608
Practice Address - Street 1:521 E 86TH AVE STE Z
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6236
Practice Address - Country:US
Practice Address - Phone:219-769-0777
Practice Address - Fax:219-755-0608
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT622732084N0400X
IL0360845062084N0400X
NY2970652084N0400X
IN02001957A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400160547OtherMEDICARE PTAN (INDIVIDUAL)
IL201614OtherMEDICARE PTAN (GROUP)
84101OtherANTHEM
IL036084506OtherMEDICAID
497970JMedicare ID - Type Unspecified
F49663Medicare UPIN