Provider Demographics
NPI:1235247248
Name:PALISADE BEHAVIORAL CARE, PA
Entity Type:Organization
Organization Name:PALISADE BEHAVIORAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-7505
Mailing Address - Street 1:50 NORTHFIELD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5320
Mailing Address - Country:US
Mailing Address - Phone:973-731-7505
Mailing Address - Fax:973-731-7513
Practice Address - Street 1:50 NORTHFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5320
Practice Address - Country:US
Practice Address - Phone:973-731-7505
Practice Address - Fax:973-731-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104558Medicaid
034502Medicare ID - Type UnspecifiedGROUP #