=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821011784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY S. MCADAM D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 385 TREMONT AVE # 561/111
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07018-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-676-1000
-----------------------------------------------------
Fax | 973-395-7082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 9TH ST APT 404
-----------------------------------------------------
City | HOBOKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07030-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-741-9941
-----------------------------------------------------
Fax | 973-395-7082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MB69844
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------