Provider Demographics
NPI:1366419632
Name:PALERMO, NICHOLAS J (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:PALERMO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:49 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-7034
Mailing Address - Country:US
Mailing Address - Phone:860-647-7055
Mailing Address - Fax:
Practice Address - Street 1:257 E CENTER ST
Practice Address - Street 2:THE OPTIMUM HEALTH BUILDING
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5214
Practice Address - Country:US
Practice Address - Phone:860-645-3927
Practice Address - Fax:860-643-2531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CTCT000151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE35625Medicare UPIN