Provider Demographics
NPI:1164260659
Name:PLACCA, JOHN ANGELO (PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANGELO
Last Name:PLACCA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1455 BROAD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3066
Mailing Address - Country:US
Mailing Address - Phone:877-532-7837
Mailing Address - Fax:
Practice Address - Street 1:2-22 BANTA PL
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3058
Practice Address - Country:US
Practice Address - Phone:877-532-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00873300363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant