Provider Demographics
NPI:1255451746
Name:PALISADES SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PALISADES SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:ADRIANO
Authorized Official - Last Name:MIGLIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-320-0922
Mailing Address - Street 1:309 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4141
Mailing Address - Country:US
Mailing Address - Phone:201-280-6150
Mailing Address - Fax:888-909-4197
Practice Address - Street 1:690 KINDERKAMACK RD STE 202
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1524
Practice Address - Country:US
Practice Address - Phone:888-320-0922
Practice Address - Fax:888-909-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB671082086S0102X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7648707Medicaid
NJ7648707Medicaid
NJ108813Medicare PIN