Provider Demographics
NPI:1235542598
Name:PERCOCO, ELLEN P (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:P
Last Name:PERCOCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2725
Mailing Address - Country:US
Mailing Address - Phone:347-598-6521
Mailing Address - Fax:
Practice Address - Street 1:110 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2725
Practice Address - Country:US
Practice Address - Phone:347-598-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY681592OtherREGISTERED NURSE