Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 014072 | NY |
NPI | 1366408742 |
---|---|
Provider Name | Randolf P Palmaira |
First Address | Fresh Meadows, NY 11365-2146 |
Second Address | Fresh Meadows, NY 11365-2146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |