Individual
KIMBERLY MITTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
179 WARBLER DR, WAYNE, NJ 07470-8470
(410) 292-5552
Mailing address
179 WARBLER DR, WAYNE, NJ 07470-8470
(410) 292-5552
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
225X00000X
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04161979
—
NY
Enumeration date
09/19/2013
Last updated
05/11/2026
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