Provider Demographics
NPI:1902265531
Name:PALLONE, ADAM (ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PALLONE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MOUNT CARMEL AVE.
Mailing Address - Street 2:GM-ATH
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1908
Mailing Address - Country:US
Mailing Address - Phone:203-582-3915
Mailing Address - Fax:203-582-3207
Practice Address - Street 1:275 MOUNT CARMEL AVE
Practice Address - Street 2:GM-ATH
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1961
Practice Address - Country:US
Practice Address - Phone:203-582-3915
Practice Address - Fax:203-582-3207
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist