Provider Demographics
NPI:1437970449
Name:PROCACCINI, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PROCACCINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 OPOSSUM RD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2626
Mailing Address - Country:US
Mailing Address - Phone:609-751-3455
Mailing Address - Fax:
Practice Address - Street 1:5 WALTER E FORAN BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4675
Practice Address - Country:US
Practice Address - Phone:908-505-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00883200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant