Provider Demographics
NPI:1629208715
Name:PERNA, JACLYN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:PERNA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:COCCHIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 STATE ROUTE 27
Mailing Address - Street 2:NORTH BRUNSWICK
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1300
Mailing Address - Country:US
Mailing Address - Phone:732-297-8866
Mailing Address - Fax:732-821-0626
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2105
Practice Address - Country:US
Practice Address - Phone:973-635-5050
Practice Address - Fax:973-635-4567
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00218700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant