Provider Demographics
NPI:1326186982
Name:KING, EDWINA SKIBA (APRN)
Entity Type:Individual
Prefix:DR
First Name:EDWINA
Middle Name:SKIBA
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:732-565-9224
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:732-565-9224
Practice Address - Fax:732-565-9225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04861500364SP0809X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS58727Medicare UPIN
NJ011653Medicare PIN