Basic Information
| Provider Information | |||||||||
| NPI: | 1962869016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACON | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | APN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 WOODSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566284504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 58 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080964626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566284504 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2016 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00612800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.