Provider Demographics
NPI:1538683719
Name:KIMBERLY BLIND RNFA, LLC
Entity Type:Organization
Organization Name:KIMBERLY BLIND RNFA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIND
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:732-207-3958
Mailing Address - Street 1:205 ROUTE 9 N STE 24
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8561
Mailing Address - Country:US
Mailing Address - Phone:732-207-3958
Mailing Address - Fax:848-444-9801
Practice Address - Street 1:2 BRENT DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8922
Practice Address - Country:US
Practice Address - Phone:732-207-3958
Practice Address - Fax:848-444-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperativeGroup - Single Specialty