Provider Demographics
NPI:1770664971
Name:PALISADE EYE ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:PALISADE EYE ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVENAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-653-5722
Mailing Address - Street 1:203 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1112
Mailing Address - Country:US
Mailing Address - Phone:201-653-5722
Mailing Address - Fax:
Practice Address - Street 1:203 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1112
Practice Address - Country:US
Practice Address - Phone:201-653-5722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3158705Medicaid
CL6963OtherRAILROAD MEDICARE
NJ3158705Medicaid
055617Medicare PIN