Provider Demographics
NPI:1699170787
Name:PALOVCAK, MARY THERESA (DNP CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:PALOVCAK
Suffix:
Gender:F
Credentials:DNP CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SCHALKS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1604
Mailing Address - Country:US
Mailing Address - Phone:609-275-9312
Mailing Address - Fax:
Practice Address - Street 1:4 SCHALKS CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014263363LF0000X
NJ26NJ00923500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily