Provider Demographics
NPI:1104660562
Name:VACCARI, ANALISE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:ANALISE
Middle Name:
Last Name:VACCARI
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Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:21 MOUNT KEMBLE AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:197 RIDGEDALE AVE STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2111
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00854900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant