Provider Demographics
NPI:1255728853
Name:CAHILL, KIM
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:CAHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:505 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4027
Mailing Address - Country:US
Mailing Address - Phone:201-447-8584
Mailing Address - Fax:201-447-8526
Practice Address - Street 1:505 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4027
Practice Address - Country:US
Practice Address - Phone:201-447-8584
Practice Address - Fax:201-447-8526
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00562300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics