Provider Demographics
NPI:1356482202
Name:CORCORAN, EILEEN M (RN, APN,C)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MAPLE PATH
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4163
Mailing Address - Country:US
Mailing Address - Phone:973-948-6859
Mailing Address - Fax:
Practice Address - Street 1:151 STATE ROUTE 10 E
Practice Address - Street 2:SUITE 105
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1452
Practice Address - Country:US
Practice Address - Phone:973-584-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07350200363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6630103Medicaid
NJ6630103Medicaid