Provider Demographics
NPI:1932306693
Name:KIMBERLY PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:KIMBERLY PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDILBERTO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ESTOMO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-244-8550
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-0029
Mailing Address - Country:US
Mailing Address - Phone:201-244-8550
Mailing Address - Fax:201-244-8549
Practice Address - Street 1:148 PARSIPPANY RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4708
Practice Address - Country:US
Practice Address - Phone:201-244-8550
Practice Address - Fax:201-244-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00520400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119384Medicare PIN