Individual
ELYSE FEARON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
382 W PASSAIC AVE, BLOOMFIELD, NJ 07003-5554
(973) 338-1900
Mailing address
87 UNION ST, CEDAR GROVE, NJ 07009-1925
(973) 908-5563
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ15226200
NJ
363LP2300X
Primary Care Nurse Practitioner
26NJ15226200
NJ
Other
Enumeration date
12/26/2024
Last updated
12/26/2024
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