Healthcare Provider Details

I. General information

NPI: 1699475368
Provider Name (Legal Business Name): PALISADES SURGICAL SUITES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRIDGE PLZ N STE 540
FORT LEE NJ
07024-7101
US

IV. Provider business mailing address

1 BRIDGE PLZ N STE 540
FORT LEE NJ
07024-7530
US

V. Phone/Fax

Practice location:
  • Phone: 804-651-5216
  • Fax:
Mailing address:
  • Phone: 551-465-5595
  • Fax: 551-465-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MCSHERRY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 708-275-7799