Healthcare Provider Details

I. General information

NPI: 1265748297
Provider Name (Legal Business Name): MRS. HEATHER KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. CHANA KING

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BLOOMFIELD AVE
VERONA NJ
07044-1366
US

IV. Provider business mailing address

110 PARK AVE
PASSAIC NJ
07055-5439
US

V. Phone/Fax

Practice location:
  • Phone: 908-239-5010
  • Fax:
Mailing address:
  • Phone: 973-594-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NJ15537200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME0067000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number6851
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: