NPIMap

Organization Active NPI

Palisade Eye Associates,P.C.

  • Ophthalmology Physician
  • Jersey City, NJ
National Provider Identifier
1770664971
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PALISADE EYE ASSOCIATES,P.C.
Practice address
203 Palisade Ave
Jersey City, NJ 07306-1112
Phone
(201) 653-5722
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Authorized official

Name
Betty Cervenak, M.D.NPI 1134228679
Title
Vice President
Phone
(201) 653-5722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

203 Palisade Ave
Jersey City, NJ 07306-1112

Mailing address

203 Palisade Ave
Jersey City, NJ 07306-1112
Phone (201) 653-5722

Other identifiers 2

IdentifierTypeStateIssuer
3158705MedicaidNJ
CL6963OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080304000035 NJ Part B Supplier - Clinic/Group Practice 1658455423 Receives reassigned benefits from 6 practitioners
Practice locations: Jersey City, NJ; Union, NJ
O20100930002496 NJ DME Supplier - Physician - OphthalmologyDME Supplier - Optician 1658455423 Practice locations: Jersey City, NJ

National Provider Directory

National Provider Directory

Locations

727 Galloping Hill Rd
Union, NJ 07083
Phone (908) 558-1717

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1770664971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 PALISADE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061112",
            "telephone_number": "201-653-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 PALISADE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061112",
            "telephone_number": "201-653-5722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALISADE EYE ASSOCIATES,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "CERVENAK",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "201-653-5722",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3158705",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL6963",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.