Provider Demographics
NPI:1356818835
Name:CAUTERUCCI, EMILEE SUSAN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:SUSAN
Last Name:CAUTERUCCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-349-8310
Mailing Address - Fax:
Practice Address - Street 1:115 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4153
Practice Address - Country:US
Practice Address - Phone:609-387-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060296363AM0700X
NJ25MP00635200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical