Provider Demographics
NPI:1346709334
Name:AIELLO, KIMBERLY SUSAN (MSOT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:AIELLO
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1312
Mailing Address - Country:US
Mailing Address - Phone:201-280-1739
Mailing Address - Fax:
Practice Address - Street 1:17 CREST DR
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1312
Practice Address - Country:US
Practice Address - Phone:201-410-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00401700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist