Provider Demographics
NPI:1578810289
Name:KIMBERLY PHYSICAL THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:KIMBERLY PHYSICAL THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDILBERTO
Authorized Official - Middle Name:ORCULLO
Authorized Official - Last Name:ESTOMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:201-951-7534
Mailing Address - Street 1:770 RIVER RD
Mailing Address - Street 2:#29
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-6600
Mailing Address - Country:US
Mailing Address - Phone:201-851-7534
Mailing Address - Fax:201-758-5095
Practice Address - Street 1:1060 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2397
Practice Address - Country:US
Practice Address - Phone:973-558-5353
Practice Address - Fax:973-558-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00520400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy