Healthcare Provider Details

I. General information

NPI: 1356482202
Provider Name (Legal Business Name): EILEEN M CORCORAN RN, APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 STATE ROUTE 10 E SUITE 105
SUCCASUNNA NJ
07876-1452
US

IV. Provider business mailing address

909 MAPLE PATH
NEWTON NJ
07860-4163
US

V. Phone/Fax

Practice location:
  • Phone: 973-584-0002
  • Fax:
Mailing address:
  • Phone: 973-948-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN07350200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: