Provider Demographics
NPI:1912036260
Name:KOBBERGER, KATHLEEN ANN (RNAPNC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:KOBBERGER
Suffix:
Gender:F
Credentials:RNAPNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3335
Mailing Address - Country:US
Mailing Address - Phone:973-379-2364
Mailing Address - Fax:973-379-6110
Practice Address - Street 1:7 UNION PL
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3656
Practice Address - Country:US
Practice Address - Phone:973-218-1776
Practice Address - Fax:908-522-1995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR02353700163W00000X
NJ26NC02353700163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJK002477Medicare ID - Type Unspecified