Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 055615 | NY |
NPI | 1154600591 |
---|---|
Provider Name | Dr. Anthony John Palumbo |
First Address | Clifton Park, NY 12065-5601 |
Second Address | Clifton Park, NY 12065-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 16/08/2011 |