Healthcare Provider Details

I. General information

NPI: 1851407415
Provider Name (Legal Business Name): ELIZABETH ERNST PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 DEANS RHODE HALL RD
MONMOUTH JUNCTION NJ
08852-3031
US

IV. Provider business mailing address

60 DEANS RHODE HALL RD
MONMOUTH JUNCTION NJ
08852-3031
US

V. Phone/Fax

Practice location:
  • Phone: 732-398-4826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00045500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: