Healthcare Provider Details

I. General information

NPI: 1386266179
Provider Name (Legal Business Name): KIMBERLY A MILETTI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LAFAYETTE AVE STE 202
HAWTHORNE NJ
07506-1928
US

IV. Provider business mailing address

32-02 HILLSIDE TER
FAIR LAWN NJ
07410-4253
US

V. Phone/Fax

Practice location:
  • Phone: 973-363-4850
  • Fax: 973-363-4606
Mailing address:
  • Phone: 201-280-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01021100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: