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NPI Code Detail

MEDICARE: MARA MICHELLE BERGANOVSKY MSN CNM WHNP-BC

MEDICARE: MARA MICHELLE BERGANOVSKY MSN CNM WHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse776424NY
2163WM0705XMedical-Surgical Registered Nurse26NR21594300NJ
3176B00000XMidwifeNY
4363LW0102XWomen's Health Nurse PractitionerF421971-01NY
5176B00000XMidwife25ME00095900NJ

General Provider Information

NPI Number : 1801730353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA MICHELLE BERGANOVSKY MSN CNM WHNP-BC
Provider Business Mailing Address
First Line : 840 NORTH RD
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2119
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 BAY AVE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-4837
Country : US
Telephone Number : 973-429-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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