Provider Demographics
NPI:1164260659
Name:PLACCA, JOHN ANGELO (PA; ATC; LAT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANGELO
Last Name:PLACCA
Suffix:
Gender:M
Credentials:PA; ATC; LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1207
Mailing Address - Country:US
Mailing Address - Phone:908-578-9623
Mailing Address - Fax:
Practice Address - Street 1:185 NJ-17
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:844-777-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002130002255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer