Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA05626700 | NJ |
NPI | 1093891723 |
---|---|
Provider Name | Robert Palacios |
First Address | Clifton, NJ 07013-3346 |
Second Address | Clifton, NJ 07013-3346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |