=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255451746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALISADES SURGICAL ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 11/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 690 KINDERKAMACK RD STE 202
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-320-0922
-----------------------------------------------------
Fax | 888-909-4197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 NEWARK AVE
-----------------------------------------------------
City | POINT PLEASANT BEACH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08742-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-280-6150
-----------------------------------------------------
Fax | 888-909-4197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MAURIZIO ADRIANO MIGLIETTA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 888-320-0922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0102X
-----------------------------------------------------
Taxonomy Name | Surgical Critical Care Physician
-----------------------------------------------------
License Number | MB67108
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number | MB67108
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MB67108
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------