Provider Demographics
NPI:1164751103
Name:DR WENDY KING, LLC
Entity Type:Organization
Organization Name:DR WENDY KING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIBA-KING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PHD
Authorized Official - Phone:732-322-5769
Mailing Address - Street 1:53 KOSSUTH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2660
Mailing Address - Country:US
Mailing Address - Phone:732-322-5769
Mailing Address - Fax:732-565-9225
Practice Address - Street 1:53 KOSSUTH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2660
Practice Address - Country:US
Practice Address - Phone:732-322-5769
Practice Address - Fax:732-565-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04861500363L00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty