Provider Demographics
NPI:1265525679
Name:PALISADE HEALTH ASSOCIATES, P A
Entity type:Organization
Organization Name:PALISADE HEALTH ASSOCIATES, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-255-2333
Mailing Address - Street 1:107 VAN BUREN DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:769 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3030
Practice Address - Country:US
Practice Address - Phone:201-261-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05823900207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7280904Medicaid
NJ5100333OtherGHI
NJ8072916003OtherCIGNA
NJEXP1K7136OtherHEALTH NET
NJP997430OtherOXFORD
NJ2025817OtherAETNA
NJ48125OtherAMERICHOICE
NJ7280904Medicaid
NJP997430OtherOXFORD
NJ7280904Medicaid
NJ=========OtherTAX ID#