1659457265 NPI number — SEBASTIAN T. PALMERI M.D

Table of content: GALE THOMASON CRNP (NPI 1891104808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659457265 NPI number — SEBASTIAN T. PALMERI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMERI
Provider First Name:
SEBASTIAN
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659457265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 SUMMERHILL RD
Provider Second Line Business Mailing Address:
SUITE 4 & 5
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-4911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-238-6440
Provider Business Mailing Address Fax Number:
732-651-1431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 SUMMERHILL RD
Provider Second Line Business Practice Location Address:
SUITE 4 & 5
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-4911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-238-6440
Provider Business Practice Location Address Fax Number:
732-651-1431
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA52870 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MA05287000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 25MA05287000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060015480 . This is a "RR MCR PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2431182 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9070857008 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F04682 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1064383 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 15632 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 780222259 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1075608 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14447 . This is a "BEECH STREET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P511095 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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