Provider Demographics
NPI:1386326700
Name:VILCACHAGUA, JENNIFER ELIZABETH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:VILCACHAGUA
Suffix:
Gender:
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:300 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 HAMPTON HOUSE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1408
Practice Address - Country:US
Practice Address - Phone:973-446-6066
Practice Address - Fax:973-446-6608
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00794200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant