=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679452148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCLUSIVE HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2025
-----------------------------------------------------
Last Update Date | 10/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2816 MORRIS AVE # 20B
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-4849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-339-3181
-----------------------------------------------------
Fax | 973-339-3182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2816 MORRIS AVE STE 20B
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-4849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-339-3181
-----------------------------------------------------
Fax | 973-339-3182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. BERGENIE CELONY
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 973-814-1278
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------