Palisade Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PALISADE SURGERY CENTER LLC

Practice address

1567 Palisade Ave
1St Floor
Fort Lee, NJ 07024-6923

Phone

(201) 585-2388

Fax

(201) 947-3860

NPI assigned

Aug 20, 2006

Last updated

Apr 16, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul Rosenberg, MDNPI 1447319777

Title

Medical Director

Phone

(201) 585-2388

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366557423. Details of each certification follow.

• CCN 31C0001219 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 31C0001219

Legal name

Palisade Surgery Center LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 7, 2007

Last certification

Dec 7, 2007

Ownership / control type

Proprietary

Facility address

1567 Palisade Avenue, 1St Floor
Fort Lee, NJ 07024

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul H Rosenberg, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Fort Lee, NJ
  • NPI 1447319777
  NPD Authorized official
• Thomas E Clinch, MD

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1437186350
  NPD (past)
• Mary Catherine Fischer, M.D.

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1306844113
  NPD (past)
• Anand Mantravadi, M.D.

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1063591402
  NPD (past)
• Hylton Richard Mayer, M. D.

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1174568695
  NPD (past)
• Kenneth S Schor, M.D.

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1407009228
  NPD (past)
• Deepika Shah, MD, MPH

  • Ophthalmology Physician
  • Chevy Chase, MD
  • NPI 1316172489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1366557423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1567 PALISADE AVE",
            "address_2": "1ST FLOOR",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246923",
            "telephone_number": "201-585-2388",
            "fax_number": "201-947-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1567 PALISADE AVE",
            "address_2": "1ST FLOOR",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246923",
            "telephone_number": "201-585-2388",
            "fax_number": "201-947-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALISADE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-585-2388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria J Pak, PHARM D
• Hong Sik Pak, M.D.
• Neetha Devassy Palatty, RPH
• Palisade Anesthesia, LLC
• Palisade Plastic Surgery Associates PC
• Palisades Dental Associates PC
• Palisades Oral Surgery
• Palisades Park Podiatry PC (Choice Podiatry of NJ)
• Palisades Surgical Suites, LLC
• Palisdes Periodontics

• Ambulatory Surgical Clinic/Center in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Ambulatory Surgical Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.