Provider Demographics
NPI:1558475087
Name:PALISADES MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PALISADES MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALANDRIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-854-5226
Mailing Address - Street 1:7600 RIVER RD
Mailing Address - Street 2:PMA
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6217
Mailing Address - Country:US
Mailing Address - Phone:201-854-5000
Mailing Address - Fax:201-854-5781
Practice Address - Street 1:6045 KENNEDY BLVD
Practice Address - Street 2:PMA
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3246
Practice Address - Country:US
Practice Address - Phone:201-453-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9021108Medicaid
NJ051725Medicare ID - Type UnspecifiedGROUP MCARE NUMBER