Provider Demographics
NPI:1528159811
Name:SCOTT, KIM J
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1654
Mailing Address - Country:US
Mailing Address - Phone:732-263-1220
Mailing Address - Fax:732-222-3019
Practice Address - Street 1:40 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1654
Practice Address - Country:US
Practice Address - Phone:732-263-1220
Practice Address - Fax:732-222-3019
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP0013110363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
089433NAFMedicare ID - Type Unspecified
NJQ39818Medicare UPIN