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General NPI Number Information
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NPI Number | 1801730353
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Entity Type | Individual
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Provider Name | MARA MICHELLE BERGANOVSKY MSN CNM WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 1 BAY AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4837
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Country | US
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Telephone | 973-429-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 840 NORTH RD
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2119
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 776424
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 26NR21594300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F421971-01
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 25ME00095900
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License Number State | NJ
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