Healthcare Provider Details

I. General information

NPI: 1124082508
Provider Name (Legal Business Name): KIMBERLY K. DENICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 3500
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD STE 3500
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7040
  • Fax: 856-566-6826
Mailing address:
  • Phone: 856-566-7040
  • Fax: 856-566-6826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06469800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: