Provider Demographics
NPI:1043224215
Name:AFORDAKOS, KIMBERLY (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:AFORDAKOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CIPRIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 LEWANDOWSKI ST
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2500
Mailing Address - Country:US
Mailing Address - Phone:201-933-9959
Mailing Address - Fax:201-933-9958
Practice Address - Street 1:418 LEWANDOWSKI ST
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2500
Practice Address - Country:US
Practice Address - Phone:201-933-9959
Practice Address - Fax:201-933-9958
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA10798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074517N5CMedicare ID - Type Unspecified