Provider Demographics
NPI:1952535593
Name:CIONGOLI, BERNARD C (DO)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:C
Last Name:CIONGOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BLACK OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7403
Mailing Address - Country:US
Mailing Address - Phone:973-220-3189
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVENUE, SUITE 2703
Practice Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER - ANESTHESIOLOGY
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-996-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09264400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology