Provider Demographics
NPI:1124134234
Name:PALMA-AQUINO, BETHZAIDA CRISANTO (MD)
Entity type:Individual
Prefix:
First Name:BETHZAIDA
Middle Name:CRISANTO
Last Name:PALMA-AQUINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETHZAIDA
Other - Middle Name:CRISANTO
Other - Last Name:PALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24 BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4009
Mailing Address - Country:US
Mailing Address - Phone:631-361-5006
Mailing Address - Fax:631-361-5006
Practice Address - Street 1:24 BRISTOL LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4009
Practice Address - Country:US
Practice Address - Phone:631-361-5006
Practice Address - Fax:631-361-5006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1633432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94767Medicare UPIN
NY91F971Medicare PIN