MEDICARE: CELESTE EGAN O'CONNOR NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	303727	NY

General Provider Information

NPI Number	:	1740401983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE EGAN O'CONNOR NP

Provider Business Mailing Address
First Line	:	432 BEACH 142ND ST
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1254
Country	:	US
Telephone Number	:	718-809-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 BEACH 142ND ST
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1254
Country	:	US
Telephone Number	:	718-809-1131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/12/2023

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