Provider Demographics
NPI:1346350584
Name:FORTE, KIMBERLY A (MED CCCA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:FORTE
Suffix:
Gender:F
Credentials:MED CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283B EGG HARBOR RD PMB 215
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-346-3823
Mailing Address - Fax:856-346-8807
Practice Address - Street 1:283B EGG HARBOR RD PMB 215
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-346-3823
Practice Address - Fax:856-346-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00022700237600000X
NJ25MG00074900237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010493Medicare ID - Type UnspecifiedPROVIDER NUMBER