Healthcare Provider Details

I. General information

NPI: 1134041544
Provider Name (Legal Business Name): KATIE BAUMGARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

116 MILLBURN AVE STE 102
MILLBURN NJ
07041-1919
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-2000
  • Fax:
Mailing address:
  • Phone: 973-376-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NR23161300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: