Healthcare Provider Details

I. General information

NPI: 1871683987
Provider Name (Legal Business Name): IRENE GRGURICH CERGNUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE G CERGNUL MD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PROGRESS ST
UNION NJ
07083-8114
US

IV. Provider business mailing address

35 BOONTON AVE
KINNELON NJ
07405-2941
US

V. Phone/Fax

Practice location:
  • Phone: 908-258-8765
  • Fax:
Mailing address:
  • Phone: 973-261-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25MA09726100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: