Basic Information
Provider Information | |||||||||
NPI: | 1710312996 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAHER | ||||||||
FirstName: | KIMBERLY | ||||||||
MiddleName: | MARIE KIRBY | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KIRBY | ||||||||
OtherFirstName: | KIMBERLY | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CNM | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 22581 | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100872581 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8566696050 | ||||||||
FaxNumber: | 8565283117 | ||||||||
Practice Location | |||||||||
Address1: | 25 LINDSLEY DR | ||||||||
Address2: | SUITE 201-A | ||||||||
City: | MORRISTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 079604455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9739987922 | ||||||||
FaxNumber: | 9739987925 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/06/2013 | ||||||||
LastUpdateDate: | 07/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 25ME00053900 | NJ | N |   | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   | 367A00000X | 25ME00053901 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   |
No ID Information.