Healthcare Provider Details

I. General information

NPI: 1255451746
Provider Name (Legal Business Name): PALISADES SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 KINDERKAMACK RD STE 202
ORADELL NJ
07649-1524
US

IV. Provider business mailing address

309 NEWARK AVE
POINT PLEASANT BEACH NJ
08742-4141
US

V. Phone/Fax

Practice location:
  • Phone: 888-320-0922
  • Fax: 888-909-4197
Mailing address:
  • Phone: 201-280-6150
  • Fax: 888-909-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMB67108
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMB67108
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMB67108
License Number StateNJ

VIII. Authorized Official

Name: DR. MAURIZIO ADRIANO MIGLIETTA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 888-320-0922