MEDICARE: KIMTRE CORP.

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	28RS00418400	NJ
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568450765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMTRE CORP.

Provider Business Mailing Address
First Line	:	251 MAIN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5709
Country	:	US
Telephone Number	:	201-947-5550
Fax Number	:	201-947-0514

Provider Business Practice Location Address
First Line	:	251 MAIN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5709
Country	:	US
Telephone Number	:	201-947-5550
Fax Number	:	201-947-0514

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES C. KIM
Credential	:	RPH
Telephone Number	:	201-947-5550

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	10/05/2011

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Directions to “KIMTRE CORP. ” Practice Location

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