Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 25MA05547100 | NJ |
Y | 2081P2900X | Pain Medicine | 25MA05547100 | NJ |
N | 2081S0010X | Sports Medicine | 25MA05547100 | NJ |
N | 213ES0000X | Sports Medicine | 25MA05547100 | NJ |
NPI | 1710960570 |
---|---|
Provider Name | Dr. Michael Alberto Palmer |
First Address | Princeton, NJ 08540-1617 |
Second Address | Princeton, NJ 08540-1617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E83642 | (02) | NJ |