Provider Demographics
NPI:1922159607
Name:CELESTIAL, ROMMEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMMEL
Middle Name:M
Last Name:CELESTIAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:ATLANTICARE REGIONAL MEDICAL CENTER
Practice Address - Street 2:JIMMIE LEEDS ROAD
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9104
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:609-404-3818
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA051584002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001826856Medicaid
NY02382387Medicaid
NJ6438903Medicaid
MD7133014Medicaid
044697ROTMedicare PIN
MD7133014Medicaid