1265591556 NPI number — PALISADE PLASTIC SURGERY ASSOCIATES PC

Table of content: (NPI 1265591556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265591556 NPI number — PALISADE PLASTIC SURGERY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALISADE PLASTIC SURGERY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265591556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1567 PALISADE AVE 3RD FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-6923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-585-2388
Provider Business Mailing Address Fax Number:
201-947-3860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1567 PALISADE AVE 3RD FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-585-2388
Provider Business Practice Location Address Fax Number:
201-947-3860
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MANAGING PHYSICIAN
Authorized Official Telephone Number:
201-585-2388

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  MA58683 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com