Provider Demographics
NPI:1972725075
Name:PALISADES ADVANCED IMAGING, PC
Entity Type:Organization
Organization Name:PALISADES ADVANCED IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-216-0066
Mailing Address - Street 1:8 RUTH COURT
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2448
Mailing Address - Country:US
Mailing Address - Phone:845-216-0066
Mailing Address - Fax:845-352-4423
Practice Address - Street 1:2 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1964
Practice Address - Country:US
Practice Address - Phone:845-216-0066
Practice Address - Fax:845-352-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWTH281Medicare ID - Type Unspecified