Provider Demographics
NPI:1669750584
Name:KAMIYAMA, KENTO (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:KENTO
Middle Name:
Last Name:KAMIYAMA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ORIENT WAY STE F217
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-327-1990
Mailing Address - Fax:201-327-1921
Practice Address - Street 1:1410 BROADWAY CONCOURSE LANE 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:201-655-9029
Practice Address - Fax:201-327-1921
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01402100225100000X
NY0382441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist