Provider Demographics
NPI:1194335372
Name:SAGE, KIMBERLY (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5568
Mailing Address - Country:US
Mailing Address - Phone:908-561-9500
Mailing Address - Fax:908-561-7162
Practice Address - Street 1:1511 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5568
Practice Address - Country:US
Practice Address - Phone:908-561-9500
Practice Address - Fax:908-561-7162
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily