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General NPI Number Information
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NPI Number | 1053484147
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Entity Type | Individual
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Provider Name | KIM R MARTIN-WIDAWSKY ANPC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 328 W SAINT GEORGES AVE
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City | LINDEN
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State | NJ
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Zip | 07036-5638
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Country | US
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Telephone | 908-925-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 77 W MAPLE AVE
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City | ALLENDALE
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State | NJ
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Zip | 07401-1206
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Country | US
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Telephone | 201-394-3329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 26NN06683300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 300344
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 300344
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NN06683300
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License Number State | NJ
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