Provider Demographics
NPI:1881871218
Name:PALLADINO, PAUL KJ (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KJ
Last Name:PALLADINO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 PORTION RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1074
Mailing Address - Country:US
Mailing Address - Phone:718-967-1228
Mailing Address - Fax:
Practice Address - Street 1:1150 PORTION RD
Practice Address - Street 2:SUITE 17
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:718-967-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist