MEDICARE: MS. BERGENIE CELONY NP

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
1	363LF0000X	Family Nurse Practitioner	F05240276	NJ
2	363LF0000X	Family Nurse Practitioner	26NJ15107200	NJ

General Provider Information

NPI Number	:	1932940475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERGENIE CELONY NP

Provider Business Mailing Address
First Line	:	155 HOLLAND RD
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2713
Country	:	US
Telephone Number	:	973-814-1278
Fax Number	:	973-339-3182

Provider Business Practice Location Address
First Line	:	2816 MORRIS AVE STE 20B
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-4849
Country	:	US
Telephone Number	:	973-339-3181
Fax Number	:	973-339-3182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	04/08/2026

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