Provider Demographics
NPI:1992732937
Name:KINGSLY, JILL H (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:H
Last Name:KINGSLY
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 1:24 SLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1537
Mailing Address - Country:US
Mailing Address - Phone:201-306-6346
Mailing Address - Fax:973-376-6447
Practice Address - Street 1:772 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1100
Practice Address - Country:US
Practice Address - Phone:973-325-0002
Practice Address - Fax:973-376-6447
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA055688002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000191Medicaid
NJ037854Medicare PIN
NJG17525Medicare UPIN
NJ058680Medicare ID - Type Unspecified