MEDICARE: PALISADES SURGICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	MB67108	NJ
2	2086S0127X	Trauma Surgery Physician	MB67108	NJ
3	208600000X	Surgery Physician	MB67108	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255451746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALISADES SURGICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	309 NEWARK AVE
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-4141
Country	:	US
Telephone Number	:	201-280-6150
Fax Number	:	888-909-4197

Provider Business Practice Location Address
First Line	:	690 KINDERKAMACK RD STE 202
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	888-320-0922
Fax Number	:	888-909-4197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAURIZIO ADRIANO MIGLIETTA
Credential	:	D.O.
Telephone Number	:	888-320-0922

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	11/10/2024

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