Provider Demographics
NPI:1801112552
Name:CALILAP-BERNARDO, CHARMANE (PNPC-PC)
Entity type:Individual
Prefix:
First Name:CHARMANE
Middle Name:
Last Name:CALILAP-BERNARDO
Suffix:
Gender:F
Credentials:PNPC-PC
Other - Prefix:
Other - First Name:CHARMANE
Other - Middle Name:B
Other - Last Name:CALILAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNPC-PC
Mailing Address - Street 1:741 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00157700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics