Provider Demographics
NPI:1346472321
Name:PALISADES REHAB AND SPINAL CARE GROUP,
Entity Type:Organization
Organization Name:PALISADES REHAB AND SPINAL CARE GROUP,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BUSSANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-840-5888
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-840-5888
Mailing Address - Fax:
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-840-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00626600111N00000X
NJ25MA06277300207LP2900X
NJ25MA04969400207R00000X
NJ25MA077898002081P2900X
NJ25MB08234500208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty