Provider Demographics
NPI:1659347177
Name:DUDAS, KIMBERLY (ANPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:DUDAS
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1703
Mailing Address - Country:US
Mailing Address - Phone:732-461-9622
Mailing Address - Fax:732-780-0014
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-461-0100
Practice Address - Fax:732-780-0014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00037300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7461402Medicaid
NJ9132902Medicaid
NJ9132902Medicaid
NJ7461402Medicaid
NJ005191Medicare ID - Type UnspecifiedMEDICARE GROUP