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NPI Code Detail

MEDICARE: MS. KIM R MARTIN-WIDAWSKY ANPC

MEDICARE: MS. KIM R MARTIN-WIDAWSKY ANPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WX0106XOccupational Health Registered Nurse26NN06683300NJ
2163WX0106XOccupational Health Registered Nurse300344NY
3363LA2200XAdult Health Nurse Practitioner300344NY
4363L00000XNurse Practitioner26NN06683300NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300344OTHERNYRN ANP LICENSE
2F300344-1OTHERNYNURSE PRACTITIONER IN ADULT HEALTH
326NN06683300OTHERNJADVANCE PRACTICE NURSE

General Provider Information

NPI Number : 1053484147
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIM R MARTIN-WIDAWSKY ANPC
Provider Business Mailing Address
First Line : 77 W MAPLE AVE
Second Line :
City : ALLENDALE
State : NJ
Zip : 07401-1206
Country : US
Telephone Number : 201-394-3329
Fax Number :
Provider Business Practice Location Address
First Line : 328 W SAINT GEORGES AVE
Second Line :
City : LINDEN
State : NJ
Zip : 07036-5638
Country : US
Telephone Number : 908-925-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 02/05/2025

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Directions to “ MS. KIM R MARTIN-WIDAWSKY ANPC” Practice Location

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