Doctor Name: | KIM M FALLON |
NPI Number: | 1013005289 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 26NJ00062300 |
Business Practice Address: | 160 Route 9 Bayville, NJ - 087211229 |
Business Phone Number: | 7323495550 |
Business Fax Number: | 7325051517 |
Mailing Address: | 160 Route 9, BAYVILLE |
State: | NJ |
Postal Code: | 087211229 |
Phone Number: | 7323495550 |
Fax Number: | 7325051517 |
NPI Enumeration Date: | 10/11/2006 |
NPI Last Update Date: | 02/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 26NJ00062300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |