=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316690878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALISADES ANESTHESIA ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2022
-----------------------------------------------------
Last Update Date | 02/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 E 88TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-410-3350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 472 N WOODLAND ST
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-674-3802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOCELYNE SAJOUS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-674-3802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------