Ebenezer Vander Pallen, RN

Primary specialty

Nuclear Imaging & Therapy PhysicianTaxonomy code 207UN0902X

License

720270 Issued in NY

Practice address

1366 Victory Blvd # B
Staten Island, NY 10301-3907

Phone

(718) 442-8351

NPI assigned

Jul 27, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samala R Swamy, MD, PC

  • Cardiovascular Disease Physician
  • Staten Island, NY
  • NPI 1003067091
  NPD (past)
• Zahir H Rahman MD PLLC

  • Cardiovascular Disease Physician
  • Staten Island, NY
  • NPI 1598413759
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501113600000",
    "number": "1760906143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1491 MACOMBS RD APT 8D",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104522145",
            "telephone_number": "718-864-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 VICTORY BLVD # B",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013907",
            "telephone_number": "718-442-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER PALLEN",
        "first_name": "EBENEZER",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-27",
        "last_updated": "2017-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0902X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "NY",
            "license": "720270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith M Van Tassell, OTR/L
• Lisa A Van Tassell, OTR/L
• Melinda Vancleaf, MSED
• David L Vancott, D.D.S.
• Patricia Vander Neut, MS. CCC-SLP
• Sydney Nicole Vanderhoof
• Jeremy C Vandevender, P.T.
• Douglas Vandyke
• Danny Vanel, CRNA
• Uday Sankar Akash Vankayala, MBBS

• Nuclear Medicine Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Nuclear Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.