Healthcare Provider Details

I. General information

NPI: 1366495871
Provider Name (Legal Business Name): KIM DONALDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

IV. Provider business mailing address

19 SHADY LN
GLEN GARDNER NJ
08826-3009
US

V. Phone/Fax

Practice location:
  • Phone: 908-859-6700
  • Fax: 908-859-6812
Mailing address:
  • Phone: 908-803-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA071581
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: