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General NPI Number Information
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NPI Number | 1568308054
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Entity Type | Individual
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Provider Name | NICOLE CEBULKO
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Gender | Female
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 456 CHESTNUT ST STE 102
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City | LAKEWOOD
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State | NJ
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Zip | 08701-6124
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Country | US
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Telephone | 732-282-7200
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Fax | 732-282-7300
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Provider Business Mailing Address
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Address Line | 1200 EATONTOWN BLVD
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City | OCEANPORT
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State | NJ
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Zip | 07757-1034
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Country | US
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Telephone | 908-692-2570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15481300
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License Number State | NJ
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