Healthcare Provider Details

I. General information

NPI: 1164751103
Provider Name (Legal Business Name): DR WENDY KING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 KOSSUTH ST FIRST FLOOR
SOMERSET NJ
08873-2660
US

IV. Provider business mailing address

53 KOSSUTH ST FIRST FLOOR
SOMERSET NJ
08873-2660
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-5769
  • Fax: 732-565-9225
Mailing address:
  • Phone: 732-322-5769
  • Fax: 732-565-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NC04861500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NC04861500
License Number StateNJ

VIII. Authorized Official

Name: DR. EDWINA SKIBA-KING
Title or Position: SOLE MEMBER
Credential: APRN, PHD
Phone: 732-322-5769