Basic Information
Provider Information
NPI: 1689263816
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALMA
FirstName: ROBERT
MiddleName: M
NamePrefix:  
NameSuffix: JR.
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 307 5TH AVE FL 6
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166575
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 245 E 84TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100282973
CountryCode: US
TelephoneNumber: 6468411414
FaxNumber: 2123792122
Other Information
ProviderEnumerationDate: 01/12/2021
LastUpdateDate: 01/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X046519-01NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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