MEDICARE: MS. MARY-ELIZABETH KATERI KILKENNY-BIELSA MA CCC-A

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	231H00000X	Audiologist		NJ

General Provider Information

NPI Number	:	1871706291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY-ELIZABETH KATERI KILKENNY-BIELSA MA CCC-A

Provider Business Mailing Address
First Line	:	209 MORRISON AVE
Second Line	:
City	:	HIGHTSTOWN
State	:	NJ
Zip	:	08520-4320
Country	:	US
Telephone Number	:	609-918-1891
Fax Number	:	609-530-3162

Provider Business Practice Location Address
First Line	:	320 SULLIVAN WAY
Second Line	:	BOX 535
City	:	TRENTON
State	:	NJ
Zip	:	08628-3405
Country	:	US
Telephone Number	:	609-530-3158
Fax Number	:	609-530-3162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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