Provider Demographics
NPI:1639308877
Name:PALISADES ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:PALISADES ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSSANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-941-3939
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-0079
Mailing Address - Country:US
Mailing Address - Phone:201-339-6971
Mailing Address - Fax:201-339-6972
Practice Address - Street 1:9226 KENNEDY BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5312
Practice Address - Country:US
Practice Address - Phone:201-339-6971
Practice Address - Fax:201-339-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06277300207LP2900X
NJ25MA07688700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty