Provider Demographics
NPI:1891082004
Name:PALLADIA INCORPORATED
Entity type:Organization
Organization Name:PALLADIA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:646-401-9700
Mailing Address - Street 1:1366 INWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3203
Mailing Address - Country:US
Mailing Address - Phone:646-401-9700
Mailing Address - Fax:646-401-9701
Practice Address - Street 1:1366 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3203
Practice Address - Country:US
Practice Address - Phone:646-401-9700
Practice Address - Fax:646-401-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23709380261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder