Provider Demographics
NPI:1124082508
Name:DENICK, KIMBERLY K (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:DENICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W ROUTE 38 STE 400
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3259
Mailing Address - Country:US
Mailing Address - Phone:562-350-2648
Mailing Address - Fax:856-235-4635
Practice Address - Street 1:212 W ROUTE 38 STE 400
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:562-350-2648
Practice Address - Fax:856-235-4635
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06469800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare PIN