Provider Demographics
NPI:1558146498
Name:BEREGE, ANGELA CHEPKEMOI (APN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHEPKEMOI
Last Name:BEREGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5823
Mailing Address - Country:US
Mailing Address - Phone:732-241-6375
Mailing Address - Fax:
Practice Address - Street 1:1610 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3018
Practice Address - Country:US
Practice Address - Phone:732-241-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14893000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health