Healthcare Provider Details

I. General information

NPI: 1902420763
Provider Name (Legal Business Name): GERGOTY BARTHELUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MORRIS AVE FL 2
LINDEN NJ
07036-4326
US

IV. Provider business mailing address

133 CARIBE CT
GREENACRES FL
33413-2149
US

V. Phone/Fax

Practice location:
  • Phone: 732-609-4774
  • Fax:
Mailing address:
  • Phone: 470-292-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049696
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360754
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17868800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: