Provider Demographics
NPI:1326213752
Name:RAYMOND, KIMBERLY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:281 ROUTE 34 STE 813
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2440
Mailing Address - Country:US
Mailing Address - Phone:732-431-2620
Mailing Address - Fax:732-431-3707
Practice Address - Street 1:281 ROUTE 34 STE 813
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2440
Practice Address - Country:US
Practice Address - Phone:732-431-2620
Practice Address - Fax:732-431-3707
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07938500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02763Medicare UPIN