Provider Demographics
NPI:1326086091
Name:PARKSIDE MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PARKSIDE MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-883-9800
Mailing Address - Street 1:1450 PARKSIDE AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2946
Mailing Address - Country:US
Mailing Address - Phone:609-883-9800
Mailing Address - Fax:609-883-4350
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-883-9800
Practice Address - Fax:609-883-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5336805Medicaid
NJ740898Medicare ID - Type UnspecifiedGROUP#