Healthcare Provider Details

I. General information

NPI: 1093565103
Provider Name (Legal Business Name): DARIA KLEMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/14/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 NJ-35 STE 240
HOLMDEL NJ
07733
US

IV. Provider business mailing address

2137 NJ-35 STE 240
HOLMDEL NJ
07733-4663
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-3535
  • Fax:
Mailing address:
  • Phone: 732-739-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI0305500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: