Provider Demographics
NPI:1740401983
Name:O'CONNOR, CELESTE EGAN (NP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:EGAN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 BEACH 142ND ST
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1254
Mailing Address - Country:US
Mailing Address - Phone:718-809-1131
Mailing Address - Fax:
Practice Address - Street 1:432 BEACH 142ND ST
Practice Address - Street 2:
Practice Address - City:NEPONSIT
Practice Address - State:NY
Practice Address - Zip Code:11694-1254
Practice Address - Country:US
Practice Address - Phone:718-809-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303727363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health