Provider Demographics
NPI:1013139740
Name:NUGENT, CECELIA (NP)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:NUGENT
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 1:388 RICHMOND TER
Mailing Address - Street 2:SUITE 6F
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1500
Mailing Address - Country:US
Mailing Address - Phone:718-447-5860
Mailing Address - Fax:
Practice Address - Street 1:67 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-3261
Practice Address - Country:US
Practice Address - Phone:732-499-9160
Practice Address - Fax:732-499-9161
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303894363LA2200X
NJ26NJ00356400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health