Healthcare Provider Details

I. General information

NPI: 1659207249
Provider Name (Legal Business Name): YICELL BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YICELL BERNARD HICIANO RN,BSN

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 VESEY ST APT 308
NEWARK NJ
07105-7112
US

IV. Provider business mailing address

42 VESEY ST APT 308
NEWARK NJ
07105-7112
US

V. Phone/Fax

Practice location:
  • Phone: 973-917-9752
  • Fax:
Mailing address:
  • Phone: 973-917-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR21114000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: