Provider Demographics
NPI:1013069152
Name:CAMACHO, MERCEDES ELENA (NP)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:ELENA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5976
Mailing Address - Country:US
Mailing Address - Phone:201-779-9910
Mailing Address - Fax:201-325-9718
Practice Address - Street 1:3300 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5976
Practice Address - Country:US
Practice Address - Phone:201-779-9910
Practice Address - Fax:201-325-9718
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN92137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025512TRJMedicare ID - Type UnspecifiedMEDICARE ID NUMBER