Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA03601100 | NJ |
NPI | 1104875046 |
---|---|
Provider Name | Glenn S. Palsky |
First Address | Lawrenceville, NJ 08648-2523 |
Second Address | Lawrenceville, NJ 08648-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2216108 | (05) | NJ |
C57272 | (02) | NJ |