Provider Demographics
NPI:1013221316
Name:PALISADES PHYSICIAN
Entity Type:Organization
Organization Name:PALISADES PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-535-3098
Mailing Address - Street 1:2 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1965
Mailing Address - Country:US
Mailing Address - Phone:845-535-3098
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1965
Practice Address - Country:US
Practice Address - Phone:845-535-3098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220382-1261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain