MEDICARE: PALISADE PLASTIC SURGERY ASSOCIATES PC

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	2086S0122X	Plastic and Reconstructive Surgery Physician	MA58683	NJ

General Provider Information

NPI Number	:	1265591556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALISADE PLASTIC SURGERY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1567 PALISADE AVE 3RD FLOOR
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6923
Country	:	US
Telephone Number	:	201-585-2388
Fax Number	:	201-947-3860

Provider Business Practice Location Address
First Line	:	1567 PALISADE AVE 3RD FLOOR
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6923
Country	:	US
Telephone Number	:	201-585-2388
Fax Number	:	201-947-3860

Authorized Official
Title or Position	:	MANAGING PHYSICIAN
Name	:	DR. PAUL H ROSENBERG
Credential	:	M.D.
Telephone Number	:	201-585-2388

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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1013099324 — ANDREW RAZIN, M.D., P.C.
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1447319777 — DR. PAUL H ROSENBERG M.D.
Practice Location Address:

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Practice Location Address:

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1760771547 — ABRAHAM PATHAK M.D.
Practice Location Address:

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