Provider Demographics
NPI:1083672604
Name:TROJAK, KIMBERLY M (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:TROJAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:TROJAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:21 HEARTHSTONE LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5363
Mailing Address - Country:US
Mailing Address - Phone:856-797-8470
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:111 CONTINENTAL DR
Practice Address - Street 2:SUITE 412
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4306
Practice Address - Country:US
Practice Address - Phone:302-709-4497
Practice Address - Fax:302-733-0854
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23NR07589700367500000X
NJ26NR07589700367500000X
PARN262198L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0650020Medicare ID - Type Unspecified