Provider Demographics
NPI:1770500357
Name:DALEY, KIMBERLY ANN (DPM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:DALEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8044
Mailing Address - Country:US
Mailing Address - Phone:732-341-3355
Mailing Address - Fax:732-341-3364
Practice Address - Street 1:555 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8044
Practice Address - Country:US
Practice Address - Phone:732-341-3355
Practice Address - Fax:732-341-3364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00200700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0718100002OtherDME
NJ0718100002OtherDME
674101Medicare ID - Type Unspecified