Provider Demographics
NPI:1144476433
Name:PALMER, DONNA (COTA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1417
Mailing Address - Country:US
Mailing Address - Phone:631-727-6180
Mailing Address - Fax:631-208-0485
Practice Address - Street 1:70 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933-1417
Practice Address - Country:US
Practice Address - Phone:631-727-6180
Practice Address - Fax:631-208-0485
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005174-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor