Provider Demographics
NPI:1518169671
Name:ELAINE BACCI, D.O.,LLC
Entity Type:Organization
Organization Name:ELAINE BACCI, D.O.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-219-7140
Mailing Address - Street 1:565 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5047
Mailing Address - Country:US
Mailing Address - Phone:732-219-7140
Mailing Address - Fax:732-219-7177
Practice Address - Street 1:565 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5047
Practice Address - Country:US
Practice Address - Phone:732-219-7140
Practice Address - Fax:732-219-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06680000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty