Provider Demographics
NPI:1700515665
Name:NISHIMURA, KUNIKAZU DAVID (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KUNIKAZU
Middle Name:DAVID
Last Name:NISHIMURA
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 1:426 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1517
Mailing Address - Country:US
Mailing Address - Phone:862-754-3566
Mailing Address - Fax:
Practice Address - Street 1:4 FOREST AVE FL 1
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5237
Practice Address - Country:US
Practice Address - Phone:201-977-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02092800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist