Individual provider Active NPI

Kim Nguyen Tibaldi, M.D.

  • Nephrology Physician
  • Livingston, NJ
National Provider Identifier
1346309531
Registry record updated Mar 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
25MA08456300 Issued in NJ
Practice address
94 Old Short Hills Rd
Livingston, NJ 07039-5672
Phone
(973) 322-5065
NPI assigned
Dec 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301083840 MI
Nephrology Physician 207RN0300X 25MA08456300 NJ Primary

Addresses

Primary practice location

94 Old Short Hills Rd
Livingston, NJ 07039-5672

Mailing address

94 Old Short Hills Rd
East Wing Suite 305
Livingston, NJ 07039-5672
Phone (973) 322-5065

Other identifiers 1

IdentifierTypeStateIssuer
0175625MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081210000103 NJ Practitioner - Nephrology 6103886114 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barnabas Health Medical Group PCGroup PAC ID 9537316955, 1,027 clinicians

Practice addresses (Care Compare)

102 James St
Edison, NJ 08820-3970
Phone (732) 494-4958

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301083840MIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barnabas Health Medical Group, PC CurrentSince Oct 1, 2023 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Oct 1, 2023 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Oct 1, 2023 Accepting new patients

Locations

200 Wyckoff Rd
Ste 3300
Eatontown, NJ 07724
Phone (732) 571-0672

102 James St
Edison, NJ 08820
Phone (551) 208-1646

355 Grand St
Jersey City, NJ 07302
Phone (201) 915-2224

377 Jersey Ave
Ste 280A
Jersey City, NJ 07302
Phone (201) 716-5850

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

94 Old Short Hills Rd
Ste 305
Livingston, NJ 07039
Phone (973) 322-5065

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

235 Millburn Ave
Ste 101
Millburn, NJ 07041
Phone (973) 376-8034

201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455

865 Stone St
Fl 1
Rahway, NJ 07065
Phone (833) 634-3278

10 Elizabeth St
Ste 303
River Edge, NJ 07661

223 Monmouth Rd
West Long Branch, NJ 07764
Phone (732) 229-3838

Interoperability endpoints

  • Direct secure messaging: ktibaldi46218@epicdirect.rwjbh.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1346309531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 OLD SHORT HILLS RD",
            "address_2": "EAST WING SUITE 305",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395672",
            "telephone_number": "973-322-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 OLD SHORT HILLS RD",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395672",
            "telephone_number": "973-322-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBALDI",
        "first_name": "KIM",
        "middle_name": "NGUYEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-06",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301083840",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA08456300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0175625",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.